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2010-11-12 19:44:06

Respiratory 1
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  1. What are Gil forceps?
    Gil Forceps are used to remove a foreign body
  2. Why should we take our time to stabilize the head?
    15% of all intubations are dislodged without head stabilization
  3. What do we do if a tube becomes displaced?
    Pull it and intubate again
  4. How many attempts do we get to intubate?
    2 then go to BLS
  5. A combitube is roughly the size of what ET tube?
  6. What size ET tube do we use on women?
  7. What size ET tube was used on an adult male?
  8. How much air do we use on a large combitube?
    • 100cc proximal
    • 15cc distal
  9. How much air do we use on a small combitube?
    • 85cc Proximal
    • 12cc distal
  10. What size person gets a large Combitube?
    5-6.5 feet
  11. What size person gets a small Combitube?
    4-5.5 feet
  12. What does BURP mean?
    • Backward
    • Upward
    • Right
    • Pressure
  13. What is the number we are looking for in capnography
  14. What is the lower (expectable) range for Pulse oxymetry?
  15. What are some factors that effect the Oxygen dissociation curve?
    • Temperature
    • pH
    • CO
    • CO2
  16. What is the corina?
    The Corina is the bifurcation in the lungs
  17. What is an endotrol?
    An endotrol is used for nasal intubation it has the pull cord
  18. What is the most common cause of a laryngospasm?
  19. What is Retrograde Intubation?
    Retrograde intubation is where a wire is fed through the exact place you circa and feed a ET tube down the wire into the trachea
  20. What is digital incubation?
    • Digital Intubation is where the neck is hyper flexed and the epiglottis is pulled forward toward the rescuer with the index finger on the epiglottis
    • Preferred way to intubate children
  21. How do you confirm a king airways placement?
    Bag compliance
  22. How much fluid do you send down an ET tube before Tracheal suction?
  23. When do you stop advancing a french catheter?
    When resistance is met of the patient begins to cough
  24. How long should we use tracheal suction?
    No more than 15 sec
  25. What is traumatic asphyxia?
    Sudden increase in venue pressure can tear the chordea tenenea
  26. What does Atelectasis mean?
    Partial or complete collapse of the lung
  27. Fractures to ribs 10-12 can result in what?
    Damage to the Liver, Spleen, Kidneys
  28. What is the definition of a "Flail chest"?
    Two or more adjacent ribs fractured in two or more places producing a free floating segment of the chest wall
  29. What is an Open Pneumothorax?
    • A hole in the chest wall that allows air to enter pleural space
    • (The Larger the hole the more likely air will enter there than through the trachea)
  30. What is ideal V?Q matching?
    4grams of O2 for every 5Liters of blood giving us a 0.8 V?Q match
  31. What is the "usual" place SQ Emphysema accumulates?
    Around the neck and shoulder
  32. What is the most field expedient way to manage an open pneumothorax?
    With a gloved hand
  33. What is the lateral location for a Needle Thoracostomy?
    Midaxillary line 4-5th intercostal space
  34. How much blood can an Intercostal artery bleed in 1 min?
  35. What is the most common injury associated with blunt trauma?
    Pulmonary contusion
  36. What is the purpose of ventilations during CPR?
    The purpose of ventilations during CPR is to maintain oxygenation and elimination of Carbon Dioxide
  37. What occasionally "blunts" the beneficial effects of chemical and electrical therapy?
    Acid-base imbalance
  38. In what patients does "auto-PEEP" substantially reduce CO and BP?
    Patients with Hypovolemia
  39. What are two concerns with an NPA?
    Airway bleeding or intracranial placement
  40. What are some different ways to recognize the placement of a ET tube?
    • Co2 detector
    • esophageal detector (Tummie syringe, Bulb syringe)
    • Auscultation
  41. Does an LMA protect the airway against aspiration?
    • It provides some protection
    • Aspiration is uncommon with LMA but not unheard of
  42. Can the LMA be used on all patients?
    Yes, however a small portion of patients can not be ventilated after the insertion of the LMA
  43. When may an EDD devise give a false reading?
    • morbid obesity
    • late pregnancy
    • status asthmaticus
  44. What are the 3 most important caveats for rescuers performing CPR after advanced airway is insert?
    • Ensure correct placement
    • Asynchronized CPR
    • Avoid excessive ventilations
  45. The installed suction unit should be powerful enough to provide? and a vacuum of?
    • Power of >40L/min
    • Vacum or >300 mmHg
  46. What is Traumatic aphyxia?
    A severe crushing injury to the chest and abdomen that causes an increase in intrathoracic pressure. The increased pressure forces blood from the right side of the heart into the veins of the upper thorax, neck and face
  47. What are the three problems with asthma?
    • Narrowing of the bronchial tubes (Contraction of the smooth muscle)
    • Inflammation (Swelling of the lining of the bronchial)
    • Excess mucus production (Globular cells become overactive)
  48. What are some SXS of Asthma?
    • Wheezing
    • Tightness in the chest
    • Trouble breathing
    • Shortness of breath
    • Cough
    • Chest pain
    • Exhaustion
    • Silent breath sounds
  49. How do we treat Asthma?
    • Albuterol or epinephrine
    • Support ABC's
    • PROP
    • Transport
    • IV (Dehydration, help break up mucus formation)
    • SPO2
    • Consider: Ipratropium (Atrovent) Corticosteroids, Magnesium Sulfate.
  50. What is the difference between Albuterol and Epinephrine?
    • Albuterol: Peak affect in 2hrs Strong effect in 20min, Epinephrine: Peak affect in 3-5min
    • Albuterol: must reach the target site, Epinephrine can be given IM or Sub-Q
    • Albuterol: Last 4-6hrs, Epinephrine: Lasts 15-20min
    • Albuterol: Affects only the part of the airway it reaches, Epinephrine: Systemic affect
  51. How far should the MDI be from the face when using?
    2 inches from the front of your mouth
  52. What must the Oxygen do before it reaches the Alveoli?
    By the time you inhale the Oxygen must be @ 98.6 degrees and 100% Humidity
  53. What is Bronchitis?
    Bronchitis is characterized by inflamed airway tissue and excessive mucus production
  54. What is Chronic Bronchitis (COPD)?
    • Chronic irritation and infection of the trachea, bronchi and bronchioles
    • Excess mucus obstructs bronchioles, interfering with alveolar ventilation
    • To have Chronic bronchitis you must have a respiratory infection for 3 months out of a year, doesn't have to be consecutive
    • Leads to persistent, productive cough
  55. What are Chronic Bronchitis SXS?
    • Sometimes the large and small airway of the lungs become narrowed, and the lining of the passageways may become scarred. This makes it hard to move the air in and out of the lungs, resulting in SOB:
    • Cough
    • Dyspnea
    • SOB
    • Wheezing
    • Ronchi
    • Blue blotters (Cyanosis and signs of right sided heart failure)
    • Most commonly caused by Cigarette smoking
    • Chronic productive cough
    • Coarse crackles
  56. How do we treat Chronic Bronchitis?
    • Support ABC's
    • PROP
    • IV
    • SPO2
    • Medication may be indicated (Albuterol)
    • (Remember, not all wheezing should get Albuterol. Albuterol for wheezing of cardiac origin may further complicate patient condition)
  57. What are the procedures for a Cricothyrotomy?
    • Locate the Thyroid Cartilage
    • Locate the Cricothyroid membrane
    • Prep the are with an antiseptic swap
    • Make a 1-inch vertical incision through the skin and subcutaneous tissue
    • Expose the cricothyroid membrane
    • Make a horizontal, transverse incision approximately 1/2 inch long through the membrane
    • Using a dilator, hemostat, or gloves finger to maintain surgical opening, insert the cuffed tube into the trachea
    • Cric tube of a 6.0 ETT is usually sufficient
    • Inflate the cuff with 5-10cc of air and ventilate the patient while stabilizing the tube
  58. What is Pierre Robin Syndrome?
    No Jaw
  59. What is Kyphosis?
    Irregular curvature of the spine
  60. What is Ankylosing Spondylitis?
    Irregular curvature of the spine where the patient is looking down
  61. What is Acromegaly?
    Large Jaw seen from Giantism in adults
  62. What is Klippel-Fiel Sundrome?
    No Neck
  63. What is the 3-3-2 rule?
    • Greater than three fingers from Jaw to Neck
    • Jaw is Greater then 3 fingers wide
    • You can open the mouth greater then 2 fingers
  64. What does LEOMON stand for?
    • Look externally
    • Evaluate the 3:3:2 rule
    • Mellampati Classification
    • Obstruction
    • Neck mobility
  65. What is the Pickwickian Syndrome?
    • Named after Joe, the sleepy, red-faced, fat boy from a charles Dickens book
    • Lung function decrease esp. if supine (be aware of respiratory issues)
    • Low lung volumes
    • Restrictive lung defect
    • Atelectasis and air trapping
    • Hypoxemic
    • Hypercapic
    • Plus COPD
    • Pulmonary Hypertension/RT-sided heart failure
  66. What does HELP stand for?
    • Head Elevated Laryngoscope Position
    • Remember this is for the non-traumatic patient
  67. What is ELM?
    • External Laryngeal Manipulation
    • The incubator manipulates the larynx by moving the thyroid cartilage with their right hand during direct laryngoscopy
  68. What does BURP stand for?
    Backward, Upward, Rightward Pressure
  69. What are the rating of head positions?
    • A=Possible
    • B=Better
    • C=Best
    • D=Incorrect
  70. What is Emphysema?
    • In emphysema, the walls between the tiny air sacs in the lungs lose their ability to stretch, and they become weakened and break. As the lung tissue become weakened and break. As the lung tissue becomes less elastic, air is trapped inside the air sax, and the exchange of oxygen and carbon dioxide is impaired.
    • Most commonly caused by smoking, Chronic disease with years of retained lung gases (Long term exposure to toxins)
    • Loss of elasticity and surface area of the alveoli
    • Causes cellular change
  71. What are the SXS of Emphysema?
    • Pink puffer
    • Dyspnea: Tripod position, Rapid - shallow breathing, Wheezing or crackles, pursed lips
    • Thin, barrel chest, clubbed fingers (Clubbed fingers only seen in emphysema)
    • (When responding to patient double the patients home O2)
    • Caused by n increase in Trypsim (digestive enzyme)
  72. What is Trypsin?
    • Trypsin is a digestive enzyme, most often found in the digestive tract, where it is used to help the body digest food
    • It is also released by immune cells in their attempt to destroy bacteria and other material
    • Excessive amounts of Trypsim is released in the lungs of the emphysema patient
    • Normally there is a balance between Alpha-1-antitrypsin and trypsin (There is an imbalance in emphysema)
  73. What can the tissue damage in emphysema cause?
    Breakdown of the alveoli also causes loss of the capillary beds surrounding them. This can lead the pulmonary hypertension which can result in an enlarged right ventricle
  74. What is the normal numerical value of End Tidal CO2?
    35mmHg - 45mmHg
  75. What are the phases of the Capnography?
    • A-B: Early Exhalation, CO2 free (dead space)
    • B-C: Combination of dead space and alveolar gas
    • C-D: Alveolar plateau
    • D: End Tidal CO2
  76. What is Capnography the vital sign for? What is Oximetry the vital sign for?
    • Capnography is the vital sign for Ventilation
    • Oximetry is the vital sing for oxygenation
  77. What does the Absent alveolar plateau indicate?
    Incomplete alveolar emptying or loss of endotracheal airway integrity
  78. Why do we use Capnography in EMS?
    • Tube verification
    • Tube vigilance
    • Judge effectiveness of ventilation
    • Identifies ROSC
    • Monitoring Hypoventilation Syndromes
    • Track Progression of Respiratory Failure
  79. What kind of different Electronic devices are there?
    • Capnometry, "Meter" of the CO2 value, either bar scale of number
    • Canogram, Waveform Graph of the CO2 values
    • Capnography, Number plus waveform
    • Mainstream, Measurement at patient adapter
    • Sidestream, Gas sample sucked into the devise for measurement there
    • "Microstream", sidestream with difference
  80. What is Ventilation?
    Movement of gas in and out of the lungs
  81. What can cause a change ETCO2?
    • Metabolism
    • Respiratory System
    • Circulatory System
    • Equipment
  82. If there is a problem in the CO2 where could the problem be?
    • Metabolism
    • Perfusion
    • Ventilation
  83. What is Hyperventilation Syndrome (HVS)?
    • HVS represents a relatively common presentation that most clinicians readily recognize. However, the syndrome has defied precise definition and explanation of the underlying Pathophysiology for the past 100yrs
    • As classically defined, HVS is a condition in which minute ventilation exceeds metabolic demands, resulting in hemodynamic and chemical changes that produce characteristic dysphonic symptoms.
    • Said simply the patient is blowing off more CO2 than they need to maintain normal pH. This results in a sense of oxygen starvation
    • Excessive deep, rapid ventilations (Excessive CO2 exhaled)
  84. What kinds of HVS are there?
    • Acute HVS accounts for only 1% of cases but is diagnosed more easily
    • Chronic HVS can present with a myriad of respiratory, cardiac, neurologic, or GI symptoms without any clinically apparent reason other than the breathing pattern
  85. What are some SXS of Acute Hyperventilation?
    • Panic, excitement
    • Deep, rapid ventilation (Air hunger, Clear bilateral BS)
    • Numbness/tingling of lips, hands and feet (Carpal/pedal spasms)
    • Sharp chest pain
    • Obvious tachypnea and hyperpnea
    • Chvostek or Trousseau
    • Tremor
    • Mydraisis
    • Pallor
    • Tachycardia
    • Depersonalization or hallucination may be noted
  86. What is Chvostek test?
    • Used in Hyperventilation
    • Tap behind the ear, if the face twitch then its positive for hyperventilation
  87. What is Trousseau test?
    Put BP cuff on, fill slightly above systolic pressure, leave on for 2-3 min, if wrist flexes then it is a positive test for hyperventilation
  88. What are the SXS of Chronic Hyperventilation syndrome?
    • Not usually apparent
    • Frequent sighing respirations, 2-3 per minute
    • Frequent yawning
    • Chest wall tenderness
    • Numbness
    • Characteristically, multiple complaints without much supporting physical evidence of disease
  89. What are some Contraindications for an LMA?
    • Greater then 14-16 weeks pregnant
    • Patients with multiple or massive injury
    • Massive thoracic injury
    • Massive Maxillofacial trauma
    • Patients at risk of aspiration
    • Not all Contraindications are Absolute
  90. What are the Steps to insert an LMA?
    • Step 1: Size selection
    • Step 2: Examination of the LMA
    • Step 3: Check deflation and inflation of the cuff
    • Step 4: Lubrication of the LMA
    • Step 5: Position of Airway
  91. How do you measure the length of an NG tube?
    • Nares to earlobe to xyphoid process
    • Mark with something
  92. How do we check placement of an NG tube?
    • Ask pt. to talk
    • Check mouth with light and tongue blade
    • Secure tube
    • Check gastric contents/ air auscultation
    • Chest/abdomen X-ray
  93. What size catheter is used for needle chest decompression?
    2-3" 12-14G
  94. What is the location for needle chest decompression?
    Second intercostal, Mid-clavicular
  95. What is the Definition of a Pulmonary Embolism?
    A pulmonary embolism is a blockage of an artery in the lungs caused by a clot that travels through the bloodstream to the lungs
  96. What is the typical SxS of a P.E.?
    • Shortness of breath that starts suddenly for no obvious reason
    • Chest pain, especially when breathing or coughing
    • Feeling faint, lightheaded, dizzy
    • Cough, sometimes with bloody phlegm
    • Rapid heartbeat
    • Rapid breathing
    • Anxiety
    • Swollen, distended neck veins
  97. What is the purpose of the Upper Airway?
    • Filter
    • Humidify
    • Warming
    • Transport
  98. What is the purpose of the lower airway?
    • Filter
    • Transport
    • Diffusion
    • Perfusion
  99. What does Hypoxemia mean?
    Decreased O2 levels in arterial blood
  100. What does Hypoxia mean?
    Decreased O2 content at the tissue level
  101. When the blood (Hemoglobin) is Alkolotic what does the O2 do?
    Easier for the hemoglobin to pick up O2, harder to release
  102. What the blood is acidic what does the O2 do?
    Harder for Hemoglobin to pick up O2, easier to release
  103. What is Ventilation?
    • Fick principle one
    • The ability for the air to get to the Alveoli
    • The actual mechanical movement
    • Requires energy (ATP)
    • Uses Intercostal muscles:
    • Internal = Forced expiration
    • External = Inspiration
    • Diaphragm
  104. What is Respiration?
    • The actual transfer of gas
    • There is Cellular respiration also
  105. What is V/Q Mismatching?
    • The V/Q ration determines the adequacy of gas exchange in the lungs
    • When alveolar ventilation matches pulmonary blood flow, CO2 is eliminated and the blood becomes fully saturated
  106. What is an Inflation Reflex?
    • Stretch reflex (Buroreceptors)
    • Cause inhibitory impulse f the vagus nerve (Prevents excessive stretch, Inhibit inspiration, Allow expiration to occur)
  107. Where are the locations of the Chemoreceptors?
    • Central (In the Medulla)
    • Peripheral (In the Carotid arteries (Bifurcation of the common carotid) and Aortic Arch)
  108. How many ribs are there?
    • 12 each side
    • 8 are true 4 are floating
  109. How many vSpinal Vertebrae are there?
    • 7 Cervical
    • 12 Thoracic
    • 5 Lumbar
  110. What is the Pleurae of the lungs?
    • Thin double layer (Perietal, Visceral)
    • Pleural space (Pleural fluid)
  111. What is the Visceral Pleura?
    Covers the actual lung
  112. What is the Parietal Pleura?
    Covers the Thoracic cavity
  113. What does TV stand for?
    Tidal volume
  114. What does IRV, ERV and RV stand for?
    • IRV: Inspiratory Reserve Volume
    • ERV: Expiratory Reserve Volume
    • RV: Residual volume
  115. How much volume does the emerge person need for visual chest rise?
    6-7cc/kg to get visible chest rise
  116. What is the most common place a Emboli can originate?
    • Leg is the most common
    • Uterus is the second most common
  117. What is the definition of a P.E.?
    A pulmonary embolism is a blockage of an artery in the lungs caused by a clot that travels through the blood stream to the lungs
  118. What is the cause of a P.E.?
    • An embolism occurs then a clot moves through the bloodstream from the location where it was formed and becomes stuck in a blood vessel. The clot, called an embolus, can be a from:
    • Blood clot
    • Air bubble
    • Piece of fat
    • Bone marrow
    • Tumor tissue
    • Can be caused by trauma, remember to look for it
  119. What is the Pathophysiology of a P.E.?
    • Once the clot is stuck in a lung artery, it blocks the blood from nourishing that lung. The tissues on the other sude of the blockage may die if it doesn't receive enough blood from other sources
    • Unlike other ischemic events; CVA or AMI the dying lung cells release toxins that cause additional lung cell to die. This can result in a P.E. that goes past the boundaries of the original insult
  120. What are the SXS of a P.E.?
    • Sudden-onset respiratory distress without difficulty moving air in and out (Normal breath sounds)
    • Hypoxia develops quickly (SpO2 low despite given O2)
    • Possible sudden, sharp chest pain
    • Signs of obstructive shock (JVD, Tachycardia)
    • Sudden SOB
    • Feeling faint, light headed and dizzy
    • Rapid breathing
    • Anxiety
  121. how do we manage a P.E.?
    • Assure adequate oxygenation and ventilation (O2 NRB @ 15lpm, Ventilate if necessary and an Upright position)
    • Rapid transport to an appropriate medical facility
  122. What is the Virchow's triad?
    • Vessel wall injury
    • Hypercoagulation
    • Venous stasis
    • Used in P.E.
  123. What is the definition of Pneumonia?
    • Pneumonia is an infection of the lungs that affects the lower respiratory tract (small bronchi and air sacs in the lungs)
    • Viral, bacterial of fungal infection of the lungs (Inflammation, fluid or puss in the lungs)
  124. What are the main causes of Pneumonia?
    • Bacteria: most commonly Streptococcus pneumonia
    • Viral pneumonia: Caused by a virus. Viruses cause half of all pneumonias
    • Atypical Bacterial pneumonia: Caused by Mycoplasmas, chlamydias, or other tiny infectious agents that have traits of both bacteria and viruses
  125. What is the short list of SXS of Pneumonia?
    • Productive Cough
    • Fever
    • Crackles
    • Wheezing
    • Pleuritic Chest Pain (Hurts to breath or cough)
  126. What is the Long list of SXS of pneumonia?
    • Fever, chills (may include shaking)
    • Cough:
    • Produces green, yellow, or rust-colored mucus
    • Dry cough
    • Violent at times; produce white mucus
    • Chest pain
    • HA
    • Possible nausea or vomiting
    • Profuse sweating
    • Muscle pain
    • Weakness
    • Cyanosis of the nails or lips
    • Confused mental state
    • Weakness
  127. How do we treat pneumonia?
    • PROP
    • Transport
    • IV
    • Monitor SPO2
  128. What are the types of pulmonary edema?
    • Cardiogenic pulmonary edema
    • Non-cardiac pulmonary edema
  129. What are the common causes for pulmonary edema?
    • Commonly due to left ventricular failure
    • Ineffective pump allows blood to back up into pulmonary circulation (Congestive pulmonary capillaries leak fluid, interfering with gas exchange)
    • Lung infection
    • Drowning
    • Toxic reaction (Smoke inhalation)
    • Pregnancy
  130. What 6 Etiology categories may pulmonary edema be placed in?
    • Secondary to altered capillary permeability
    • Secondary to increased pulmonary capillary pressure
    • Secondary to decreased oncotic pressure found with hypoalbuminemia
    • Secondary to lymphatic insufficiency
    • Secondary to large negative pleural pressure with increased end expiratory volume
    • Secondary to mixed or unknown mechanisms
  131. What are the causes of Altered Capillary Permeability?
    • ARDS
    • Infectious causes
    • Inhaled toxins
    • Circulating exogenous toxins
    • Vasoactive substance
    • Disseminated intravascular Coagulopathy (DIC)
    • Immunologic processes reaction
    • Uremia
    • Near drowning
    • Other aspirations
  132. What can cause Increased Pulmonary Capillary Pressure?
    • Pulmonary venous thrombosis (P.E.)
    • Stenosis or veno-occlusive disease
    • Volume overload
  133. What are the SXS of Pulmonary Edema?
    • Extreme dyspnea
    • Wet lung sounds
    • Pink, frothy sputum
    • Peripheral edema
    • JVD
    • Tachycardia
    • Hypertension
    • Skin may be diaphoretic or cold, gray, and cyanotic
    • Wheezing or rales
    • Lower extremity edema
    • Position
    • Frothy sputum
    • Blood tinged sputum
  134. What is an Antigen?
    An Antigen is a toxin or other foreign substance that induces an immune response in the body, produces antibodies
  135. What is an Antibody?
    An antibody is a protein produces by the immune system in response to the presence of an antigen
  136. What is the Physiology of Anaphylaxis?
    • Exposure
    • Manufacture of IgE antibody
    • Antibody attach to MAST cells
    • Second exposure causes MAST cells to release powerful chemicals
  137. What are the SXS of Anaphylaxis?
    • Usually occurs < 30min of exposure to allergen (Hives and swelling)
    • Respiratory distress
    • Hypotenstion
    • Altered Mental status
  138. What is Urticaria, angioedema and anaphylaxis are manifestations of the immediate hypersensitivity reaction. Immediate hypersensitivity reaction that occurs within minutes to hours of exposure to a particular antigen by an immune individual. Twenty percent of the population will have one of these manifestations, especially urticaria. Pathophysiology
  139. What is Uticaria?
    Hives are an intensely itchy rash that consists of raised, irregularly shaped wheals. The wheals have blanched center, surrounded by a red flare. Urticaria is caused by histamine released from dermal mast cells. Histamine release is most commonly causes by an immunologic reaction between antigens and IgE antibodies bound to mast cell membranes. Histamines cause increased vascular permeability. Antigens, chemicals and physical agents (Detergents or ultraviolet light) can cause urticaria.
  140. What is Angioedema?
    Angioedema is an area of circumscribed swelling of any part of the body. It may be caused by the same mechanisms that cause hives
  141. What is Angioneurotic Edema?
    • An allergic reaction
    • Edema of the tongue and pharynx, larynx
    • NOT the SAME as anaphylaxis
  142. What is Anaphylaxis?
    • Anaphylaxis is the acute reaction that occurs when an antigen is introduced systemically into an individual who has preexisting IgE antibodies
    • Affects big 3 systems
  143. What is the Mellampati Classifications?
    A method used by Anesthesiologist, reliable to predict difficulty directing Laryngoscopy
  144. What are the classifications of Mallampati?
    • Class I: Soft palate, uvula, faces and pillars are visible
    • Class II: Soft palate, uvula and faces visible
    • Class III:Soft palate, base of uvula visible
    • Class IV: Hard palate only visible
  145. What are the Grades of Cormack and Lehave?
    • POGO (Percentage Glottic Opening Observed)
    • Grade I: Largely open
    • Grade II: Wide but short
    • Grade III: Short and narrow
    • Grade IV: No visible opening
    • All refer to the larynx
  146. What does Atelectasis mean?
    Partial or complete lung collapse
  147. What is the definition of a Flail chest?
    • 2 or more ribs broken in 3 or more locations
    • Visible flail segment Paradoxical movement
  148. Which ribs are the most commonly fractured?
    • 5-8 according to Cy
    • 4-8 according to the book
  149. Fractures to ribs 10-12 cause to damage to what underlying organs?
    • Liver
    • Spleen
    • Kidneys
  150. What is Marfan's syndrome?
    • Can cause a Spontaneous pneumothorax
    • Tall, thin males
  151. What is an Open Pneumothorax?
    • Hole in the chest wall that allows air to enter pleural space.
    • Larger the hole the more likely air will enter than through the trachea
  152. What is the most common location for SQ emphysema?
    Around the neck
  153. What is the most field expedient way to manage a Open Pneumothorax?
    With a Gloved hand
  154. What is a Tension pneumothorax?
    A tension pneumothorax is a Pneumothorax that compresses the lung to where is is symptomatic
  155. What is a Hemothorax?
    A Hemothorax is where blood accumulates in the pericardial sac, creating tension. A Tension pneumothorax but with blood
  156. What is Cardiovascular Trauma?
    An patient with significant blunt or penetrating trauma to chest has heart/great vessel injury until proven otherwise
  157. What is a Pericardial Tamponade?
    Rapid accumulation of blood in the inelastic pericardium
  158. What is Beck's Triad?
    • Resistant hypotension
    • Increased central venous pressure (Distended neck/arm veins in presence of decreased arterial BP)
    • Small quiet heart (Decreased "Muffled heart tones)
  159. What is Pulses Paradoxicus?
    Different pressure inspiration VS. Expiration
  160. What is Traumatic Asphyxia?
    • Increased Intrathoracic pressure
    • Backward flow of blood out of right heart into vessels of upper chest and neck
    • Name given to these patients because they looked like they had been strangled or hanged
  161. What is a Diaphragmatic Rupture?
    • Usually due to blunt trauma but may occur with penetrating trauma
    • Usually life threatening
    • Likely to be associated with other severe injuries
  162. How do we Manage a Tracheobronchial Rupture?
    • Establish airway, consider early intubation
    • Emergent transport (Intubating Right or Left mainstem may be life saving
  163. How do we manage Esophageal Injuries?
    • Establish airway
    • Consider early intubation if possible
    • IV LR/NS titrated to BP 90-100mmHg
    • Emergent Transport
  164. How do we manage a Diaphragmatic Rupture?
    • Establish airway
    • Assist ventilations with high concentration O2
    • IV of LR
    • monitor EKG
    • NG tube if possible
  165. How do we manage Traumatic Asphyxia?
    • Airway with C-spine control
    • Assist ventilations with high concentrations of O2
    • spinal stablilization
    • IV of LR
    • Monitor EKG
    • MAST in severely hypotensive patients
    • Rapid transport
  166. How do we manage Traumatic Aortic Dissection/Rupture?
    • Establish airway
    • High concentration O2
    • Maintain minimal BP in dissection
    • IV LR/NS TKO
    • Emergent transport
  167. What are some upper respiratory infections?
    • Influenza
    • Sinusitis
    • Pharyngitis/Tonsillitis
    • Epiglottis
    • Laryngitis
  168. What is Influenza?
    Influenza is a highly contagious viral respiratory tract infection
  169. What is acute/subacute and chronic Sinusitis?
    • Acute Sinusitis: This type of infection occurs quickly and gets better with the appropriate treatment
    • Subacute Sinusitis: This type of infection does not get better with treatment initially and lasts less then three months
    • Chronic Sinusitis: These symptoms last longer then three oaths
  170. What is Pharyngitis and Tonsillitis?
    • Pharyngitis and tonsillitis are infections in the throat that cause inflammation. If the tonsils are primary affected, it is called tonsillitis. If the throat is primarily affected, it is called pharyngitis. A person might even have inflammation and infection of both the tonsils and the throat. This would be called Pharyngotonsillitis.
    • Bacterial infections are more common during the winter, Viral infections are more common in the summer and fall.
  171. What is Epiglottis?
    Epiglottis is a life-threatening condition that occurs when the epiglottis - a small cartilage "lid" that covers the windpipe - swells, blocking the flow if air into the lungs.
  172. What is Laryngitis?
    • Laryngitis is an inflammation of the voice box (larynx) due to overuse, irritation or infection. Normally your vocal cords open and close smoothly, forming sounds though their movement and vibration. But laryngitis, the vocal cords become inflamed or irritated. They swell, causing distortion of the sound produced by air passing over them. As a result, the voice sound hoarse. In some cases of laryngitis, the voice can become so faint as to be undetectable. Laryngitis may be acute or chronic. Although acute laryngitis usually is nothing more than an irritation and inflammation fro a virus, persistent hoarseness can signal a more serious problem.
    • Croup in children