Medic - General

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FlyingSheep
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227968
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Medic - General
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2013-08-19 10:15:46
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Medic General
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Semester 1
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  1. P Wave
    First deflection from isoelectric line, represents atrial depolarization, occurs just prior to atrial contraction, positive upright and rounded. Marks the contraction of the both atria. 

    Normal length can vary between 0.08-0.11
  2. Q Wave
    First deflection of the QRS complex, represents depolarization of bundle of His. It is upright or positive deflection. Is the initial wave if there is no Q wave. Can be benign or a sign of an MI. 

    Considered significant if it is 0.03 seconds or wider. Or if it's height is equal to or greater than 1/3 of the R wave. If either are true, an MI is in place. 

    Q waves are often insignificant in leads I, aVL, and V6 due to intervened by the septal. Called septal Qs.
  3. Tp Wave
    Normally obscured by the QRS. It represents atrial repolarization. It deflects in the opposite direction of the P wave.
  4. S Wave
    • Final wave of QRS complex, represents
    • depolarization of the bundle branches. Negative or downward deflection.

    Marks contraction of Left ventricle.
  5. R Wave
    Initial or second wave of the QRS complex. Represents depolarization of bundle of His.Upright or positive deflection. Is the initial wave if there is no more Q wave.

    Marks the contraction of the Right ventricle.
  6. T Wave
    Deflection from baseline ventricular, represents repolarization of the ventricle, positive or upright

    Marks point where ventricles are relaxing.
  7. U Wave
    Small deflection following after the T wave. Represents after-polarization. Positive or upright in deflection, not typically seen.
  8. J Wave
    • Also known as the Osborn wave. Positive deflections at the junction between the QRS complex and the
    • ST Segment. Present in patients suffering from severe hypothermia.
  9. PR Segment
    Time frame between the end of the P wave and the beginning of the QRS complex. Can be depressed by less than 0.8mm under normal circumstances. Anything greater may be pathological (pericarditis) or in an atrial infarct (very rare).
  10. PR Interval
    • P wave plus PR segment. Period of time
    • for stimulus to travel across the atria and delay at AV node.
  11. ST Segment
    • Point from  J wave to T wave. Beginning of
    • ventricular repolarization.
  12. QT Interval
    Beginning of QRS complex to end of T wave. Represents ventricular depolarization and repolarization.
  13. TP Segment
    Point from end of T wave to start of next depolarization. Represents the isoelectric line.
  14. Atrial depolarization is depicted on the EKG as the ____ wave.
    P Wave
  15. Ventricular depolarization is depicted on the EKG as the
    ___ wave.
    QRS wave
  16. Atrial repolarization is depicted on the EKG as the ___ wave.
    P wave
  17. Ventricular repolarization is depicted on the EKG as the ___ wave.
    T wave
  18. In a normal heart with the normal pacemaker function, the electrical impulse originates in the ___ node.
    SA wave
  19. The period of time between atrial systole and preceding ventricular systole is depicted on the EKG as the ____ segment.
    TP Segment
  20. The ___ node is the area in the cardiac conduction system where a slight pause in impulse conduction occurs so that the atria can empty fully into the ventricles.
    AV node
  21. The _____ is the first area of the conduction
    system where a normal impulse travels at the beginning of the QRS complex.
    Bundleof His
  22. When the impulse is in the Purkinje fibers, this is depicted on the EKG by the ______.
  23. Ventricular diastole is depicted on the EKG by the ________.
    Isoelectric Line
  24. The ____ segment depicts the time when the ventricles have depolarized and are about to repolarize.
    ST
  25. The ____ interval depicts the total time for ventricular depolarization and repolarization.
    QT
  26. RR Interval
    Point from one QRS complex to the next, represents the rate.
  27. Interventricular Septum
    Wall dividing the ventricles, also houses the Bundle Branches.
  28. PP Interval
    Caused from Mobitz Type I AV block, where the atria fire but ventricles do not. This causes the QRS complex to not appear and only shows a P wave followed by another P wave.
  29. Premature Ventricular Contraction (PVC). Rhythm is irregular as it's premature. 

    Rate is dependent on the underlying rhythm. No P wave before the PVC, QRS measures over 0.12 seconds and is wide.
  30. Sinus Arrhythmia
    R-R intervals change generally with pattern following patient respiratory rate. R-R decrease upon inhalation and increase on exhalation. 

    60-100 beats/min. 

    Standard uniformed P waves. PRI measures 0.12 - 0.20 and consistent. QRS > 0.12
  31. Premature Junctional Contraction (PJC)
  32. Left Axis Deviation
  33. Normal Axis
  34. detail wpw Wolff Parkinson White (WPW) syndrome
    • Wolff-Parkinson-White Syndrome
    • Presence of an extra, abnormal electrical pathway in the heart that leads to periods of a tachycardia.
  35. Right Axis Deviation
  36. List the three major body systems
    Respiratory, Cardiovascular, Neurological
  37. What do cells use to make energy (metabolism)?
    glucose and oxygen (whenever possible)
  38. Describe anaerobic metabolism
    Cells metabolize glucose to make a small amount of energy. One unit of glucose produces two units of energy. Some lactic acid as an unwanted (waste) by product is produced as well.
  39. Describe aerobic metabolism
    Cells metabolize glucose (one unit of glucose makes two units of energy) and then additional processes take oxygen and the lactic acid waste / by product from anaerobic metabolism and produce an additional two units of energy in the first part (Kreb’s cycle) followed by another 30 or more units of energy in the second phase (electron transport chain) for a total energy production of 35-38 units of energy----about 19 or 20 times more than would have been produced with only anaerobic metabolism.
  40. Does anaerobic metabolism stop during aerobic metabolism?
    No---anaerobic metabolism continues as long as glucose is available but the by product (lactic acid) builds up in the tissues.
  41. Why is aerobic metabolism necessary?
    To make enough energy in an efficient manner. The two units of energy from one unit of glucose in anaerobic metabolism is just not enough to support full cell functioning and it uses a lot of glucose for just a little bit of energy.
  42. In order to support aerobic metabolism, what is needed?
    glucose AND oxygen
  43. How do we get oxygen to the cells?
    m, what is needed? glucose AND oxygen8. How do we get oxygen to the cells? The respiratory system brings in air with oxygen in it and then diffuses the oxygen into the bloodstream at the alveoli. From there, the cardiovascular system circulates the oxygen (riding on the hemoglobin on red blood cells) to the cells. The neurological system controls the breathing rate and depth, the heart’s pumping rate and strength and the blood vessels (vascular container) size.
  44. What is an alveolus?
    One of many millions of microscopic air sacs in the lungs
  45. If the respiratory system anatomy is an “upside down tree”, what are the leaves on that tree?
    alveoli
  46. What part of the cardiovascular system is found wrapped around the alveoli?
    pulmonary capillaries---the smallest and thinnest blood vessels
  47. Describe diffusion as it relates to respiration
    Diffusion in respiration is the tendency of oxygen to even out (balance) its concentration across a membrane. If that membrane is between the alveolus and the pulmonary capillary, oxygen tends to be in higher concentration in the alveolus than in the pulmonary capillary and so oxygen moves into the blood. The reverse occurs with carbon dioxide (CO2) in the pulmonary capillary since there is less CO2 in the alveolus than in the blood at that point. At the capillary in the systemic circulation (at the tissues of the body), there tends to be more oxygen in the blood than in the cell and there tends to be more CO2 in the cell (it was produced during metabolism as a waste / by product), so oxygen diffuses into the cell from the blood while CO2 diffuses into the blood from the cell.
  48. Where does diffusion occur during cellular respiration?
    In the pulmonary capillaries and in the systemic capillaries
  49. What is the role of the respiratory system in maintaining cellular respiration (metabolism)?
    Bring in O2 and exhale CO2
  50. What is the role of the cardiovascular system in maintaining cellular respiration?
    Deliver O2 from the lungs to the cells in the body and remove CO2 from the cells and transport it to the lungs.
  51. What is the role of the neurological system in maintaining cellular respiration?
    Control of blood vessel size (muscular tone), control of breathing rate and depth, control of heart pumping rate and strength.
  52. What does the prefix “hypo” mean?
    Low
  53. What is hypoxia?
    Low oxygen levels in the cells
  54. What is perfusion?
    circulation or blood flow to the cells
  55. What is hypoperfusion?
    low blood flow to the cells
  56. Describe blood flow from a capillary in the toe all the way through the heart and pulmonary circulation and back to the toe.
    Femoral V - I. Vena - Right Atria - R Ventricle - pulmonary vein - bronchiole - aveioli - pulmonary arteries - left atria - left ventricle - aorta - arteries - capillaries - happy toe. 

    Oxygenated blood is diffused into the cells at the same time deoxygenated is diffused into the blood stream. The deoxygenated blood is then carried through veins into the femoral vein and into the inferior vena cava,
  57. Define arteries.
    Vessels with muscular walls that carry blood away from the heart and branch off the aorta. Can constrict or dilate.
  58. Define arterioles.
    Vessels that branch off of arteries and carry blood away from the heart. Can constrict or dilate.
  59. Define capillaries
    The smallest of vessels that branch off of arterioles and then spread out into the tissues to supply individual cells. Capillaries merge into venules.
  60. Define venules
    Smallest division of the venous system that carries blood from the capillaries back toward the heart. Can constrict or dilate---has valves to prevent backflow.
  61. Define veins.
    Carries bloods back toward the heart. Can constrict or dilate. Valves prevent backflow.
  62. Define aorta.
    Largest vessel on the arterial side---exits from the heart. Receives blood from the left ventricle
  63. Define vena cava.
    Largest vessel on the venous side. Empties into the right atrium.
  64. Do arteries carry oxygenated or deoxygenated blood? Explain your answer.
    On the systemic side, arteries carry oxygenated blood but, in the pulmonary circulation, arteries carry deoxygenated blood. In all cases, arteries carry blood away from the heart.
  65. What about veins----do they carry oxygenated or deoxygenated blood? Explain.
    Veins carry blood toward the heart. The pulmonary vein carries oxygenated blood back toward the heart from the lungs. Otherwise, veins carry deoxygenated blood back toward the heart from the systemic circulation.
  66. Define atria
    Upper chambers of the heart that hold blood until the ventricles have emptied and then contract to push blood into the ventricles thereby providing a small amount of stretching of the ventricular chamber.
  67. Define ventricles
    Lower chambers of the heart that pump blood from the heart. The RV pumps to the lungs while the LV pumps to the systemic circulation.
  68. Describe the arterial and venous circulation in terms of pressure, volume, presence of valves, description of bleeding.
    Arterial circulation is high pressure and low volume compared to the venous circulation’s low pressure but high volume. The venous side has valves. Arterial bleeding is under pressure and tends to spurt whereas the venous side’s lower pressure provides a “flowing” bleeding.
  69. Explain the role of hemoglobin and red blood cells in respiration.
    Hemoglobin molecules on the red blood cells have sites for oxygen to bind so that oxygen can be carried from the lungs to the systemic circulation to the tissues
  70. Define hematocrit
    The percentage of the blood volume taken up by red blood cells.
  71. Define plasma.
    The portion of the blood that is not red blood cells or white blood cells / platelets. Plasma is mostly water and occupies the majority of the volume of the blood in most cases.
  72. Define serum.
    The portion of plasma that is not fibrinogen. Serum does not contain blood cells or clotting factors. Serum does contain electrolytes and proteins.
  73. Describe the blood flow through the heart and lungs including the valves.
    Blood enters the RA from the systemic circulation. The RA dumps blood through the tricuspid valve into the RV which pumps blood through the pulmonic valve to the PA. Blood returns to the heart from the lungs via the PV which dumps into the LA. From the LA, blood flows through the bicuspid valve to the LV which pumps through the aortic valve to the aorta and thus the systemic circulation.
  74. List the three major body systems.
    Respiratory, Cardiovascular, Neurological
  75. Identify major bones of the body on a diagram, on yourself and on a partner including:

    Cranium, Clavicle, Scapula, Humerus, Radius, Ulna, Olecranon, Carpals, Metacarpals, Phalanges, Patella, Tibia, Fibula, Tarsals, Metatarsals, Calcaneus, Phalanges, Femur, Iliac crests, Ischial tuberosity, Spine (regions and number of vertebra), Maxilla, Mandible, Sternum
    Cranium, Clavicle, Scapula, Humerus, Radius, Ulna, Olecranon, Carpals, Metacarpals, Phalanges, Patella, Tibia, Fibula, Tarsals, Metatarsals, Calcaneus, Phalanges, Femur, Iliac crests, Ischial tuberosity, Spine (regions and number of vertebra), Maxilla, Mandible, Sternum
  76. Identify common “directionals” on a diagram, on yourself and on a partner including:

    Anterior, Posterior, Inferior, Superior, Medial, Lateral, Proximal, Distal
    • Anterior: In front, before
    • Posterior: Back, behind
    • Inferior: Lower
    • Superior: Higher
    • Intermediate: In between
    • Medial: closer to middle
    • Lateral: closer to side
    • Proximal: close to heart
    • Distal: further away from heart
  77. Identify the abdominal quadrants on a diagram, on yourself and on a partner.
    Right/Left Upper Quadrant, Right/Left Lower Quadrant
  78. Describe the location and function of the atria
    Superior or “top” chambers of the heart. Left and right atria serve to hold blood until the ventricles are ready to fill and then the atria contract to force the ventricles to fill completely and stretch slightly
  79. Describe the location and function of the ventricles (in the heart).
    Inferior or “bottom” chambers of the heart that serve to pump blood from the heart. The right ventricle pumps to the lungs while the left ventricle pumps to the systemic circulation
  80. Describe the location and function of the aorta
    Largest artery in the body; arises from left ventricle and then branches into arteries.
  81. Describe the location and function of the vena cava.
    Largest vein in the body; empties into the right atrium
  82. Describe the location and function of the arteries.
    Branches off the aorta; muscular walls that can constrict or dilate; branch into arterioles.
  83. Describe the location and function of the arterioles
    Branches off the arteries that become progressively smaller and deliver blood to the capillaries.
  84. Describe the location and function of the capillaries.
    Smallest blood vessels; receive blood from arterioles and then deliver blood to venules; capillaries exchange nutrients and gases with the cells.
  85. Describe the location and function of the venules.
    Smallest vessels on the venous side; receive blood from capillaries and deliver to veins.
  86. Describe the location and function of the veins.
    Receive blood from venules and deliver to the vena cava; can dilate or constrict; at least 2/3 of the total blood volume is in the venous circulation at any one time.
  87. Explain the concept of “pump, volume and container” as it describes the functioning of the Cardiovascular System.
    The heart pumps the blood volume through the vascular container to provide perfusion. Problems with any of the three parts can lead to hypoperfusion. Paramedics can manipulate the functions of each of the three parts.
  88. Discuss the mechanics of breathing including the concept that normal breathing includes the active process of inhalation and the passive process of exhalation.
    The brain triggers a breath by commanding the diaphragm to contract (flatten out---move “downward”) which creates a slight negative pressure (vacuum) inside the chest. Air flows toward that negative pressure providing that the airways are open. This process requires energy and is an “active” process. Accessory muscles of breathing in the abdomen, neck and between the ribs (“intercostals”) can be used to assist the diaphragm. The parietal pleura lines the chest wall while the visceral pleura covers the outside of the lung. The two pleural linings adhere to each other under normal circumstances so that when the chest wall expands, the lungs expand along with the chest wall. Exhalation is normally passive (no energy required) and simply involve relaxation of the diaphragm and chest wall.
  89. Explain the role of the smooth muscle in the walls of blood vessels and bronchioles.
    Smooth muscle walls of the bronchioles and blood vessels are under the control of the nervous system. When the brain determines that more airflow is needed into the lungs, the bronchiole wall muscles can be commanded to relax. When the brain determines that blood pressure is dropping in the central circulation, the smooth muscle walls of arteries can be commanded to constrict thereby reducing the size of the arterial “container’ and increasing central blood pressure.
  90. Identify body positions on a diagram, on yourself and on a partner: Supine, Prone, Lateral Recumbent, Fowler’s, Semi-Fowlers, Trendelenburg
    • Supine - Laying down on back. 
    • Prone - Laying down on stomach.
    • Lateral Recumbent - Laying on side
    • Fowler's - Sitting up at an angle to elevate head, with knees slightly elevated. 
    • Semi-Folower - Head elevated less
    • Trendelenburg - supine with feet higher than head.
  91. Identify the mid-clavicular line and the anterior axillary and mid-axillary line:
    Midclavicular Line - roughly located at nipple, center of the clavicle. 

    Anterior Axillary Line - line right at the armpit down the side of the outline of the body. 

    Mid Axillary Line - Line going down the middle of the side of the body. 

    Posterior Axillary Line - Line going down the end of the armpit roughly at the "start" of the back.
  92. Define the “mediastinum” and list the structures found there.
    The area in the center of the thoracic cavity that contains the heart, trachea, aorta, vena cava
  93. Describe the location and function of the alveoli
    Microscopic air sacs at the end of the pulmonary tree encircled by capillaries; the location of the exchange of oxygen and carbon dioxide in the lungs.
  94. Describe the location and function of the diaphragm.
    The primary muscle of respiration; forms the inferior border of the thoracic cavity separating the abdominal and thoracic cavities; contracts to create negative pressure for inhalation.
  95. Describe the location and function of the pleura.
    The parietal pleura lines the chest wall while the visceral pleura covers the outside of the lung. The two pleural linings adhere to each other under normal circumstances so that when the chest wall expands, the lungs expand along with the chest wall.
  96. Explain how diffusion occurs in the lungs and in the peripheral tissues and discuss the flow of oxygen and carbon dioxide in each location.
    Diffusion is the tendency for oxygen (or carbon dioxide) to “even out” between the capillaries and the cells (in the peripheral tissues) or the alveoli (in the lungs). In the lungs, there is more O2 in the alveoli as fresh air has been inhaled than there is in the blood returning from the peripheral tissues. So, O2 moves into the blood from the alveoli. The reverse occurs in the peripheral tissues where there is more O2 in the incoming blood than there is in the cells. So, O2 moves from the blood to the cells. In both cases, carbon dioxide concentrations and movements are opposite to that of oxygen.
  97. What does the term tachycardia mean?
    Rapid heart rate
  98. What does the term hypotension mean?
    Low blood pressure
  99. What does the term apnea mean?
    Lack of breathing
  100. What does the term hypertension mean?
    High blood pressure
  101. What does the term bradycardia mean?
    Slow heart rate
  102. What does the term tachypnea mean?
    Fast breathing
  103. What does the term hypoglycemia mean?
    Low blood glucose.
  104. Define hypoxia
    Inadequate oxygen in the tissues.
  105. List at least one problem with the cardiovascular system that could lead to hypoxia
    Pump not delivering blood to lungs or tissues; blood clot in lungs (pulmonary embolus) preventing part of lung from perfusing; blood or blood volume loss or red blood cell deficiency (anemia) causes hypoxia because there are insufficient ways for oxygen to be delivered; heart rate too slow or too fast to provide adequate cardiac output to circulate blood
  106. List at least one problem with the respiratory system that could lead to hypoxia.
    Lower airway obstruction from asthma / bronchitis; lower airway damage from COPD; lung collapsed or bruised; chest wall not intact; low inspired oxygen
  107. List at least one problem with the neurological system that could lead to hypoxia.
    Decreased respiratory drive from poor brain functioning due to low cerebral perfusion, low glucose supply for the brain, brain swelling.
  108. The cardiovascular system has three main components. List them.
    Pump, Blood volume, vascular container system
  109. How could a pulmonary embolus cause hypoxia?
    Embolus blocks perfusion of the lung which prevents oxygenation of the blood.
  110. How could right ventricular failure (CHF) cause hypoxia?
    Poor perfusion of the lung leading to reduced oxygenation of the blood.
  111. How could left ventricular failure (CHF) cause hypoxia?
    Poor cardiac output leading to reduced oxygen delivery AND poor left ventricular function produces pulmonary vascular congestion / pulmonary edema which impairs oxygenation.
  112. How could an extremely rapid heart rate cause hypoxia?
    Poor cardiac output due to reduced ventricular filling time.
  113. How could an extremely slow heart rate cause hypoxia?
    Poor cardiac output due simply to too few contractions.
  114. How could a loss of blood volume from vomiting and diarrhea cause hypoxia?
    Inadequate perfusion due to reduced volume
  115. How could a loss of blood volume from bleeding cause hypoxia?
    Inadequate quantity of “delivery vehicles” for oxygen.
  116. How could a low level of red blood cells (anemia) cause hypoxia?
    inadequate quantity of “delivery vehicles” for oxygen.
  117. How could carbon monoxide poisoning cause hypoxia?
    inadequate quantity of “delivery vehicles” for oxygen because CO occupies space on the red blood cells where O2 would normally be carried---CO latches onto the space and occupies it for an extended time.
  118. How could extreme vasodilation from anaphylaxis or sepsis cause hypoxia?
    Reduced perfusion to do reduction in pressure from inappropriate increase in container size
  119. How could obstructive shock from a tension pneumothorax cause hypoxia?
    Reduced perfusion due to obstruction of vena cava which causes reduced preload and therefore reduced cardiac output. Reduction in perfusion alone can lead to hypoxia. Add to that the decrease in available lung for oxygenation due to the pneumothorax.
  120. How could entrapment in a confined space cause hypoxia?
    Reduction in the O2 available in the air for inspiration.
  121. How could a lower airway obstruction (asthma or bronchitis) cause hypoxia?
    Decreased air intake due to the obstruction---coupled with air trapping due to outflow obstruction.
  122. How could COPD (emphysema) cause hypoxia?
    Damaged alveolar surface leads to reduction in gas exchange.
  123. How could a pulmonary contusion cause hypoxia?
    Bruised lung tissue is filled with blood thereby impairing oxygenation.
  124. How could pneumonia cause hypoxia?
    Pus filled lung tissue has impaired oxygenation.
  125. How could rib fractures cause hypoxia?
    Impaired ventilation due to pain leads to decreased oxygenation.
  126. How could inappropriate restraint practices (“hog tie”) cause hypoxia?
    Impaired ventilation due to positioning that doesn’t allow chest expansion---leads to decreased oxygenation.
  127. How could a heroin overdose cause hypoxia?
    Reduced ventilation due to impaired brain function which leads to decreased respiratory drive (“commands”).
  128. How could a severe traumatic brain injury cause hypoxia?
    Reduced ventilation due to impaired brain function which leads to decreased respiratory drive (“commands”).
  129. Define hypoperfusion.
    Inadequate delivery of blood flow to tissues.
  130. The cardiovascular system has three main components. List them.
    • Heart / Pump
    • Blood / Fluid Volume
    • Vessels / Container
  131. How could an extremely slow heart rate cause hypoperfusion?
    Inadequate heart rate impacts cardiac (pump) output---one of the three main components.
  132. How could an extremely fast heart rate cause hypoperfusion?
    Inadequate time for the ventricles to fill reduces cardiac (pump) output.
  133. How could a weak or damaged left ventricular muscle cause hypoperfusion?
    Inadequate stroke volume reduces cardiac (pump) output.
  134. What two factors determine cardiac output?
    Heart Rate and Stroke volume
  135. How can perfusion be inadequate even if no blood volume is lost?
    Inadequate perfusion can be from pump problems or container size problems even if there are no blood volume problems.
  136. As a patient’s perfusion drops, what happens to their body temperature?
    Inadequate perfusion can lead to hypothermia.
  137. Why does the body use vasoconstriction to compensate for poor perfusion and why isn’t that harmful?
    Inadequate perfusion to the heart / lung / brain for only a few minutes can be fatal but inadequate perfusion to peripheral tissues (skin or muscles in the arms or legs for example) can be withstood for several hours in most cases. The body can use vasoconstriction as a temporary means to compensate for problems with perfusion.
  138. List a possible cause of “distributive” shock (abnormally large vascular container).
    Sepsis, neurogenic shock, anaphylaxis.
  139. List a possible cause of cardiogenic shock
    Cardiac muscle damage from “heart attack” (myocardial infarction); cardiac tamponade
  140. A reduction in preload has what impact on perfusion?
    Cardiac output depends on “input”---preload. As preload drops, cardiac output tends to drop. An increase in heart rate would be expected to result.
  141. Name at least two things that can cause a reduction in preload
    Vasodilation, obstruction of the vena cava (as in tension pneumothorax)
  142. List 5 signs of hypoperfusion.
    Altered Mental Status (Anxiety, Restlessness, Irritable, Confused, Fearful)

    Tachycardia, Tachypnea, Cool / Pale / Moist Skin

    Hypotension (loss of peripheral pulses, measured BP)
  143. Which of those signs is typically the first but most subtle or potentially overlooked?
    Altered Mental Status
  144. Which three of those signs typically show up together as a result of the body’s attempt to compensate for a drop in central perfusion?
    Tachycardia, Tachypnea, Cool / Pale / Moist Skin
  145. Which of those signs is the most obvious sign of hypoperfusion and typically occurs after all the other four?
    Hypotension (loss of peripheral pulses, measured BP
  146. List 5 treatments for hypoperfusion that can be used by basic life support providers.
    • - Supine position (do not need to elevate legs or use Trendelenburg)
    • - Maintain warmth (expose to assess but cover back up to treat)
    • - Provide oxygen
    • - Control external bleeding
    • - Rapidly transport to definitive care
  147. List signs of hypoxia and explain how each might be overlooked or attributed to another problem besides hypoxia.
    Altered Mental Status is a sign of hypoxia---and many other things such as blood sugar problems or body temperature problems or drug / alcohol use or brain trauma or confusion post-seizure or severe infection or stroke or other things.

    Tachycardia may indicate hypoxia or it may indicate pain or fear or emotional upset.

    Tachypnea may indicate hypoxia or it may be related to emotional upset or metabolic problems.

    A low oxygen saturation as measured by pulse oximetry indicates hypoxemia which is not the same as hypoxia but they frequently occur together---however, that pulse ox reading may be inaccurately low if the perfusion is compromised to the area where the probe is attached.
  148. How can paramedics manage hypoperfusion by adjusting cardiac output?
    If the heart rate is too fast or too slow, paramedics can correct it.If the stroke volume is too low, paramedics may be able to improve it by improving preload using fluids or vasoconstrictors or....stroke volume may be improved directly using beta 1 agonist positive inotropes.
  149. How can paramedics manage hypoperfusion by adjusting blood volume?
    Hypovolemia can be treated to some extent by volume replacement---at least temporarily. Also, when the container is inappropriately large (dilated), the relative hypovolemia can be corrected by fluid administration.
  150. How can paramedics manage hypoperfusion by adjusting “container” size?
    Vasoconstrictors or vasodilators can be used to manipulate the container size.
  151. Anaerobic  Metabolism
    Uses glucose instead of air to produce energy.
  152. Aerobic Metabolism
    Produces energy for cells by using oxygen.
  153. Hypoxemia
    Low oxygen content in the blood which may lead to hypoxia (low oxygen content in the tissues)

    Sign/Symptoms: Altered mental status, tachycardia, tachypnea

    Measure with pulse oximetry, results could be in error as a result of high carbon monoxide exposure or high ambient light levels.
  154. Hypoperfusion
    Perfusion depends on proper function of three major body systems: Cardiovascular, Respiratory, and Neurological
  155. Hypoperfusion - Cardiovascular
    Pump, volume, container

    Pump: output determined by heart rate x stroke volume

    Hypovolemia: Assessed through orthos. Lay down for one minute, then stand up and check after 1 minute. Looking for a 20 point rise in HR and perhaps systolic BP. 

    Container: vessel size regulated by neuro/hormonal system.
  156. Hypoperfusion - Respiratory
    Diffusion occurs in the alveoli (equal O2/CO2 gain/lost) through pulmonary capillaries.
  157. Capnography
    If metabolism produces CO2 and if perfusion transports the CO2 to the lungs, then low capnography readings indicate high ventilation rates. High capnography readings indicate low ventilation rates. 

    However, low metabolism or low perfusion may produce low capnography readings.
  158. Hypoperfusion - Neurological
    Controls heart rate and vessel size via two divisions: The autonomic nervous system's sympathetic and parasympathetic systems. 

    Sympathetic (Flight or Fight): increases heart rate and strength of contraction and therefore increases cardiac output or shrinks vessel size for increased pressure. 

    Parasympathetic: Rest and digest, decreases heart rate.
  159. Hypoperfusion Signs and Symptoms
    Altered mental status, tachycardia, tachypnea, cool/pale/moist skin, eventually loss of peripheral pulses and hypotension (measure low BP).

    Anxiousness, restlessness, heart racing, short of breath, weak, dizzy, nausea.
  160. Hypotension - BP Measurements
    Trend more helpful than an isolated number, when trending keep all variables as similar as possible (Same ears, same bp cuff, same arm, ect...)

    Can use a machine BP, not accurate with movement.
  161. Mean Arterial Pressure
    The average pressure in the system, can calculate or use a chart or most monitors.
  162. Atrial Kick
    Adds an additional 25% and stretches the ventricle.
  163. R (RPMABC)
    • - Rate and Regularity of Rhythm
    • - If Regular: 300, 150, 100, 75, 60, 50, 43, 37, 33, 30
    • - If Irregular: Count QRS
  164. P (RPMABC)
    P Waves and other Parts (P's for every QRS / a QRS for every P).
  165. M (RPMABC)
    • Measurements.
    • - PRI (0.12-0.20 seconds or 120 to 200 milliseconds) 
    • - QRS < 0.12 seconds or up to 120 milliseconds)
  166. A B C (RPMABC)
    Axis, Bundle Branch Blocks, Changes in ST and T
  167. Cardiac electrical nodes and their firing rate:
    • SA:                   60-100 BPM
    • Artiral Cells:       55-60 BPM
    • AV:                   45-50 BPM
    • His Bundle:        40-45 BPM
    • Bundle Branch:   40-45 BPM
    • Purkinje Cells:    35-40 BPM
    • Myocardial Cells: 30-35 BPM

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