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automated external defibrillator
4 modes of infection transfer
Blood settling in lowest point of body in death
implied versus informed consent
- implied: PT unable to consent for some reason, but they would want it.
- Informed: PT gives consent
body is laid flat on the back (supine position) with the feet higher than the head
Modified Trendelenburgs / Shock
Back/Head Horizontal, legs raised
8 possible anatomical position on a gurney
- Modified Trendelenburgs / Shock
- Fowlers position
- Right Lateral Recumbent
- Left Lateral Recumbent
- Recovery Position
7 direction terms
3 types of muscle
- Skeletal (aka striated)
Base of Trachea called?
pleural space is?
The space between the pleural membranes that surround the lungs and the chest cavity.
%CO2 in expiration
3% ~ 5%
hypoxic drive is?
- form of respiratory drive in which the body uses oxygen chemoreceptors instead of carbon dioxide receptors to regulate the respiratory cycle.
- The hypoxic drive is so weak that unconsciousness will develop before respiratory distress is noted.
Normal Resp Rate for Adult
Normal Resp Rate for Child
Normal Resp Rate for Infant
Normal Pulse Rate for Adult
Normal Pulse Rate for Geriatric
Normal Pulse Rate for Child
Normal Pulse Rate for Infant
Normal BP for Adult
Normal BP for Child
Normal BP for Infant
Normal Ventilation Rate for Adult?
- 1 breath per 5 seconds (12 / min)
- 1 breath per 3 seconds (20 / min) if ICP suspected
Normal Ventilation Rate for Child
1 breath per 3 seconds (20/ min)
Normal Ventilation Rate for Infant
1 breath per 3 seconds (20/ min)
Flow rate and %O2 provided of Nasal Cannula?
- 1~6 L/min
- provides 24~44% inspired O2
Flow rate and %O2 provided of Nonrebreathing Mask?
- 10~15 L/min
- provides 90% inspired O2 @15 L/m
%O2 provided by Mouth-to-mask (breath only)?
provides 16% inspired O2
Flow rate and %O2 provided by Mouth-to-Mask with gas?
- 15 L/min
- provides 55% inspired O2
Flow rate and %O2 provided by BVM?
- 15 L/min
- ~100% inspired O2
Chronic obstructive pulmonary disease
shortness of breath
Per Os (PO)
Per Rectum (PR)
Subcutaneous (SQ) or (SC)
Metered Dose Inhaler
Define the Breath sound: Crackles
Crackling rattling breath sounds: Fluid in alveoli.
Define the Breath sound: Rhonchi
Course gurgling breath sounds: Chronic mucus in airways
Define the Breath sound: Stridor
Harsh high pitched barking resps: Upper airway obstruction
Define the Breath sound: Wheezing
- Whistle-like tone: caused by air passing through partially obstructed respiratory passages.
- Originating: in smaller lower passages.
- Conditions: Asthma or COPD
Define the Breath sound: Snoring
Tongue obstructing airway in supine position
Define the Breath sound: Rales
- Small clicking, bubbling, or rattling sounds in the lung: Fluid is in the lung in some form.
- They are believed to occur when air opens closed air spaces.
Define the Breath sound: Gurgling
- Air bubbling through fluid in upper airway.
- low pitched and loud: caused by air passing through respiratory passages that have narrowed or been partially obstructed by secretions, edema, tumors, etc
- Gurgles are and often alter in quality after the patient coughs.
- Rhonchi is the older term for gurgles.
Define the Breath sound: Pleural friction rubs
harsh and scratchy, somewhat like two pieces of sandpaper being rubbed together: Caused by the rubbing together of inflamed and roughened pleural surfaces.
Location and Function of Spleen?
- located in the left upper quadrant of the abdomen.
- It removes old red blood cells recycling iron.
- Holds a reserve of blood in case of hemorrhagic shock
What's the movement: Adduction?
Movement of limb towards midline
What is the "Anatomic Position"?
Pt standing facing you, arms at their sides, palms forward.
Angle of louis?
Ridge on the Sternum lying where the second rib attaches to sternum.
What is the name of the ridge on the Sternum lying where the second rib attaches to sternum?
Angle of louis.
What are the bony prominences of the pelvis (ilium) at the front on each side of the lower abdomen just below the plane of the umbilicus?
Anterior Superior Iliac Spines
Location of Carpalmetacarpal joint?
Between the Wrist and Metacarpals and the thumb
Location of Cecum?
First part of large intestine into which the ileum opens.
3 parts of the lyrynx?
- Thyroid Cartilage (top)
- Cricothyroid membrane (middle)
- Cricoid Cartilage (bottom)
Artery on front of foot?
Dorsalis Pedis Artery
Hole in base of skull for spinal cord
What's the hole in base of skull for spinal cord?
What's the bony prominence on the proximal lateral side of the thigh just below the hop joint?
Anatomy of inguinal ligament?
a band running from the pubic symphysis to the anterior superior iliac spine.
Upper quarter of sternum?
- a conical prominence projecting from the undersurface of the mastoid portion of the temporal bone and is roughly pyramidal or conical in shape.
- A point of attachment for several muscles
a fusion of two bones along the palatal fissure that form the upper jaw.
- Lower jaw
- a fusion of two halves at the mental symphysis.
Vertical line through Axilla (armpit).
Vertical line through armpit?
Vertical line through clavical
most posterior portion of cranium
Sebaceous gland produces?
Muscles that act to flex and rotate the head.
small cartilaginous process (extension) of the lower part of the sternum
small cartilaginous process (extension) of the lower part of the sternum?
Irregular and inadequate respirations
Crioid pressure (and aka?)
- Sellick manouver
- pressure on the cricoid cartilage to occlude the osophagus when ppv'ing
Shortness of breath
accumulation of fluid in the space between the aveoli and pulmonary capillaries
Characteristics of Bronchitis?
- inflammation of the lungs
- cough & production of sputum
- Fluid accumulates in lung tissue
- Ability to exchange gasses reduced
Characteristics of Diptheria?
- sore throat, low fever, and an adherent membrane on the tonsils, pharynx, and/or nasal cavity that obstructs the passage of air.
- contagious but rare
Characteristics of Pneumonia?
- Acute infection with fever, cough, and sputum
- Fluid accumulates in lung tissue
- Ability to exchange gasses reduced
Characteristics of Epiglottitis?
- Bacterial infection of Epiglottis
- Pre-shool & school aged kids can have Epiglottis swell to 2 or 3 times size
- Stridor heard
- Sore throat
Characteristics of Croup?
- Inflammation and swelling of whole airway
- Seal bark cough
- drooling as too painful to swallow
Characteristics of COPD?
- co-occurrence of chronic bronchitis and emphysema, in which the airways become narrowed.
Characteristics of Emphysema?
- Dyspnea on exertion
- barrel chestedness
- accessory muscles usage
- They may have trouble coughing and lowered amounts of sputum.
- Caused by destruction of structures feeding the alveoli, airflow is impeded and air becomes trapped
- An accumulation of air in the pleural space
- aka a collapsed lung
a buildup of fluid between the layers of tissue that line the lungs and chest cavity.
S/S of Pulmonary Embolism?
- Acute chest pain
Loss of consciousness
CPR/AED Sequence (unwitnessed arrest)?
- 1. Open the AIRWAY with either head tilt/chin lift or modified jaw thrust, if the airway is clear, check for a gag reflex and maintain the airway with an OPA/NPA
- 2. Check for BREATHING for 10 secs by look, listening and feeling for the rate, rhythm and depth
- 3. lf no breathing, give 2 breaths with a BVM @ 15 L/m
- 4. Check pulse
- 5. If there IS a pulse, continue rescue breathing at 1:5 (12/min) for an adult, or 1:3 (20/min) for a child/infant or a patient with suspected ICP
- 6. If there is NO pulse start compressions 30:2
- 7. Apply the AED while compressions are going on
- 8. After 2 minutes of CPR (5 cycles) analyze using the AED
- 9. If shock advised, deliver 1 shock and then start directly into 2 minutes of CPR starting with chest compressions. No pulse check at this time
- 10. If no shock advised, check pulse,
- a) If no pulse continue with compression for 2 minutes then analyze again (start back at line 6)
- b) If there is a pulse, continue with rescue breathing (start back at line 5)
- Things to remember:
- If in a moving ambulance, stop the ambulance and turn the engine off before analyzing
- If hypothermic (body temp below 35deg) only 1 shock is to be delivered on scene, no more than 3 shocks delivered, or 3 no shock advised
- Expiry Date
6 Medical Rights
- Documentation - of the other 5
When performing suction, what is max suction time for adults?
Adult: 15 seconds
When performing suction, what is max suction time for children?
Child: 10 seconds
When performing suction, what is max suction time for infants?
Infant: 5 seconds
Asthma - difficulty inhaling or exhaling?
s/s of respiratory distress?
- nasal flaring
- pursed lips
- inability to talk
- accessory muscle usage
- tripod position
- unusual breath sounds
symptoms of Pleuritic chest pain?
- sharp & stabbing
- worsened by deep breaths or chest wall movement
- often caused by inflamation of pleura
partial or complete accumulation of air in pleural space
Broadly describe the path of blood flow from Right Atrium through body and back again to RA.
- Right Atrium to...
- Right Ventrical to...
- Pulmonary Artery to...
- Lungs to...
- Pulmonary Veins to...
- Left Atrium to...
- Left Ventrical to...
- Body to...
- Superior & Inferior Vena Cava to...
- Right Atrium
- repeat for 76 years
Calcium and Cholesterol plaques form on walls of blood vessels obstructing flow and dilation/contraction.
- inside space of a tubular structure, such as an artery or intestine.
- So, not the lining per se, but the space it encapsualtes, aka "hole".
- Death of tissue.
- not just MI
Usual time for Angina to last?
- 3 - 8 minutes
- rarely longer than 15mins
s/s of Angina
- Chest pain
s/s & Vitals of MI
- Pulse: increases & arrhythmias
- BP: could do anything really
- Resps: Normal or dyspnea for Pts with congestive heart failure
- LOC: syncope
- pulmonary edema
- pain/discomfot/pressure in: Chest / Back / neck / lower jaw / arms / abdomen
- without an obvious cause, the sudden onset of...
- --- weakness
- --- N/V
- --- Cold Diaphoresis
- --- mild cyanosis or grey skin,
- --- feelings of impending doom
- --- DEATH!
s/s difference between Angina and MI?
- MI pain may or may not: be caused by exertion
- MI pain may or may not: be relieved by Nitro
- Does not resolve in a few minutes
- 1/3 of people never seek help (cardiac denial)
- Older women, being the hags that they are, sometimes just think it's "indigestion"
- Ventricular tachycardia (VT)
- electrical activity starts in Ventricle instead of Atrium.
Ventricular Fibrillation: Disorganized quivering of the Ventricles. Defibrillation resets the fucker.
- Flatline: No electrical activity in the heart.
- Take their wallet, they wont need it.
Define Cadiogenic Shock?
Heart isn't able to pump enough blood around the body causing lack of perfusion.
s/s of Shock?
- Anxiety & Restlessness
- Air hunger (Pt says they “cant breath” yet they obviously can, their brain is sensing lack of O2)
- Pallor & diaphoresis
- Pulse increases
- Final stage: BP drops
Tx of Cardiogenic shock?
- Semi fowlers, or if low BP, then supine
- PPV prn
s/s of Congestive Heart Failure?
- Sitting up makes it easier to breath: lying down causes more blood to return to RV and lungs increasing pulmonary edema
- Pt agitated
- Chest pain
- JVD when sitting
- Edema in legs
- High BP
- Rapid Resps
- Rapid pulse
- Accessory muscle usage
- Rales / crackles breath sounds
Tx for Congestive Heart Failure?
- NRB 15lpm
- Sit or gurney, legs hanging down
Define Congestive Heart Failure?
Ventricles not strong enough to pump blood around the body causing buildup of fluid in lungs
Define dependant edema?
Swelling of fluid in body closest to the ground due to CHF
Swelling or enlargement of an artery that can burst
Explain the Cincinnati Stroke Scale?
- Facial droop: Have the person smile or show his or her teeth
- Abnormal: One side of face does not move as well as the other (or at all)
- Arm drift: Have the person close his or her eyes and hold his or her arms straight out in front palms up for about 10 seconds.
- Abnormal: One arm does not move, or one arm drifts down compared with the other side
- Speech: Have the person say, "You can't teach an old dog new tricks," or some other simple, familiar saying.
- Abnormal: Slurred or inappropriate words or mute
Transport positioning for stroke?
- LLR or RLR: paralyzed side down with plenty of padding.
- Elevate the head about 6”
What are the 3 responses assessed by the GCS?
- Eye opening
- Verbal response
- Motor response
GCS: Eye opening?
- Alert (opens eyes spontaneously): 4
- Verbal (opens eyes to words): 3
- Pain (opens eyes to pain): 2
- Unresponsive: 1
- Oriented conversation: 5
- Confused conversation: 4
- Inappropriate words: 3
- Incomprehensible sounds: 2
- None: 1
- Obeys commands: 6
- Localizes pain (tries to swat your hand): 5
- Withdraws/pulls away from pain: 4
- Abnormal flexion from pain: 3
- Abnormal extension from pain: 2
- None: 1
If a Pt sees an “Aura” what’s likely to happen next?
- They may have a seizure
- They may charge you for a psychic reading
Cerebrovascular Accident: Any interruption of blood flow to the brain resulting in loss of brain function
Coup-contrecoup brain injury?
Brain injury on opposite side of original impact
Brain injury on opposite side of original impact?
Coup-contrecoup brain injury
Inability to pronounce speech clearly as a result of the brain not being able to control small muscles of the larynx
They can understand, but not speak back properly
They can speak clearly, but not understand
As a result of fevers
Weakness in one side of the body
Period after a seizure (5 to 30 mins) with laboured breathing and some AMS
Seizures reoccur every few minutes or last more than 30 mins
Rhythmic back and forth motion of and extremity and body stiffness
Lines the abdominal cavity
Covers the organs
Irritation of the peritoneum
Severe intermittent cramping abdominal pain
Pain felt in one body area yet caused by a different area
Pelvic inflammatory disease: generic term for inflammation of the uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs.
Sudden onset of pain usually indicating Peritonitis
Loss of appetite
Inflammation of gall bladder
Inflammation of the bladder
- Diverticulitis is swelling (inflammation) of an abnormal pouch (diverticulum) in the intestinal wall.
- These pouches are usually found in the colon
Paralysis of the bowels, stopping peristalsis
Inflammation of the Pancreas
3 P’s of uncontrolled diabetes?
- Polyuria: Frequent and Plentiful pissing
- Polydipsia: Frequent drinking
- Polyphagia: Frequent eating because the cells are starving for glucose
uncontrolled diabetes DKA?
- Diabetic Ketoacidosis: Acids accumulate in the boy when insulin is not available. Caused by Hyperglycemia
- Abdominal pain
- Kussmaul respirations: Deep rapid resps
Deep rapid resps: from DKA
Breath smell of Hyperglycemia?
- Hypoglycemia shock
- Insufficient glucose in the blood
What does insulin do?
Allows glucose to enter the cells
Released during anaphylaxis. Increase badness or reaction.
Raised swollen well defined area from an insect bite or reaction.
4 routes of poison entering the body?