Block 2 Quiz Study Flash Cards

What are the structures of the upper airway?

Nasal air passage: warms, filters, and humidifies air

Mouth

Epiglottis: flap of the esophagus, protects larynx from food

Glottis: voice box in the middle of the larynx

Pharynx: 

• Nasopharynx: behind the nasal passage

• Oropharynx: behind the mouth

• Laryngopharynx: behind the larynx

Larynx: voice box

What are the structures of the lower airway?

Trachea: windpipe

Lungs (well duh)

Carina: where the trachea divides into 2 branches

Main Bronchi: thickest lung branch

Bronchioles: thinnest lung branch

Pulmonary capillaries

Alveoli: air sacs where respiration occurs (where O2 and CO2 are exchanged)

What are the parts of the pelvic bones?

Coxae: ilium (and iliac crest), pubis, ischium, pubic symphysis (connecting cartilage) and acetabulum joint

What is the physiological mechanism that triggers breathing to occur?

CO2 detection:

1. Medulla oblongata (in brain stem) detects a high pH (high CO2 → high pH) in the CSF (cerebrospinal fluid)

2. Medulla oblongata stimulates phrenic nerve

3. Phrenic nerve stimulates diaphragm

4. Diaphragm increases in contractions and tidal volume

Hypoxic drive detection: Sensors in brain, aorta walls, and carotid arteries detects low O2 in blood

What are agonal respirations? What should be done if there is agonal respiration?

Not true breathes. They are gasps triggered by the hypoxic brain sending signals to breathing muscles.

They appear sudden, slow, and shallow, and are common in cardiac arrest.

Rx: Ventilate with BVM

What are the signs and symptoms of an Acute Myocardial Infarction?

Signs:
irregular heart beat and syncope (fainting)
Shortness of breath/dyspnea
Pink, frothy sputum (possible pulmonary edema)

Sudden death

Symptoms:

Sudden onset of weakness, nausea, and sweating w/o an obvious cause

Chest pain, discomfort, or pressure (crushing or squeezing that does not change w/ each breath)
Pain, discomfort or pressure in the lower jaw, arms, back, abdomen, or neck

Nausea/vomiting

What is hyperventilation and what are the causes of hyperventilation?

Hyperventilation: rapid breathing to a point that CO2 levels in the arteries are below normal

Acidosis: the build up of acid (caused by high CO2 in the blood)

The body tries compensate for acidosis, by lowering the concentration of CO2

What is happening to the body during sepsis?

In septic shock infections release toxins that damage the vessel walls, causing the walls to leak (hypovolemia) and unable to constrict (widespread vasodilation)

When does neurogenic shock occur?

Damage to or pressure on the cervical spine. 

This prevents brain stem signals being sent to musculature and blood vessels. 

This causes widespread vasodilation and bradycardia which results in hypotension.

Hypotension leads to hypoperfusion.

What are the phases of the cardiac cycle?

Systoyle

Diastoyle

Pulse pressure

Preload

Afterload

Stroke Volume (SV)

Cardiac output (CO)

Systemic vascular resistance (SVR)

What is pulse pressure and its components?

Systoyle	Pressure w/in arteries when LV contracts	Indicates Pump efficiency Blood availability
Diastoyle	Pressure w/in arteries when LV relaxes (heart at rest)	Indicates Adequate cardiac relaxation Amount of blood w/in vessels
Pulse pressure	Systolic BP - Diastolic BP	Indicates body’s response to stress

What is cardiac output?

Stroke Volume (SV)	Amount of blood moved w/ one contraction of the LV	Weak → less blood per beat
Cardiac output (CO)	Volume of blood pumped per minute	CO = SV*HR

HR = Pulse Rate

What is preload, afterload, and systemic vascular resistance?

Preload	Amt of blood returning to heart	Too little → BP falls Too high → hear cannot move blood effectively
Afterload	Pressure to be overcome when LV contracts, or Pressure w/in aorta	Afterload = diastolic pressure

Systemic vascular resistance (SVR)

Resistance to blood flow w/in all vessels (excluding pulmonary vessels

Higher SVR = smaller container; therefore, higher BP in the vessel

What is the chain of survival in a pediatric cardiac arrest from recognition to ROSC?

1. Recognition and activation of emergency response system

   1. (Unresponsive)

   2. Hypoxia: dyspnea, apnea

   3. bradycardia, or pulseless

2. Immediate oxygenation: Open airway and Ventilate

   1. Jaw thrust if suspected spinal injury

   2. Chin lift if no spinal injury

3. Immediate, high-quality CPR

   1. 5 cycles, 2 mins

   2. 30:2 compressions to ventilations for 1 rescuer / 15:2 for 2 rescuers

4. Rapid defibrillation

   1. Reassess pulse w/ AED after 1 cycle of 30:2

5. BLS & ALS care

6. ALS and post arrest care

7. Recovery

How do you manage mild upper airway obstruction?

Encourage the patient to cough or continue coughing, give supplemental oxygen if needed, and transport to the ED.

How do you manage severe upper airway obstruction?
How about when the pt is pregnant or obese?

Abdominal thrust maneuver for responsive patients: increases intrathoracic pressure by thrusting the subdiaphragmatic region.

1. Stand behind the patient, arms around the patient, and legs straddling the outside of patient’s legs

2. Fist in one hand covers the other, thumb above the umbilicus below the xiphoid process.

3. Thrust fist upward quickly.

4. Continue thrusts if the object is expelled or the patient is unresponsive.

Chest thrust maneuver if the patient is pregnant or obese.

What is the difference between systolic and diastolic blood pressure?

Systolic BP: the pressure on the arteries when the left ventricle contracts/pumps blood into the aorta.

Diastolic BP: the resting pressure in the arteries b/w contractions when the ventricle is relaxed and refilling with blood.

How do you calculate a Glasgow Coma Scale?

Eye opening score + Verbal response score + motor response = GCS

What does each GCS score mean?

Score: 15 = No neurologic disabilities

Score: 13-14 = Mild dysfunction

Score: 9-12 Moderate dysfunction

Score >8 severe dysfunction

What are the physiological characteristic effects of epinephrine?

Epinephrine is a sympathomimetic (mimics the effect of the sympathetic NS). Increases in heart rate, increases BP, vasoconstriction, and bronchodilation.

What is the difference between generic and brand names of common drugs?

Generic: simple, clear, nonproprietary name approved by FDA.

Trade: brand name given by the manufacturer.

How do you manage a patient in respiratory distress, even with COPD?

Adults w/ >20< breaths/min → high flow O2 15L/min w/ CPAP, or BVM if mental status declines, distress is moderate to severe, or depth of respirations is inadequate

Monitor and reassess respirations every 5 mins until the ED

If pt has long-standing COPD and probable CO2 retention → low flow O2 2L/min then adjust to 3-4L/min and so on until symptoms improve.
Decrease in respiratory rate after O2 admin does not mean pt no longer needs O2, pt may need it even more. If the rate slows and pt becomes unconscious, assist in breathing w/ a BVM.

Monitor O2 deprivation with pulse oximetry.

What should you do with a patient’s medications on a call?

Verify what medications are taken, how much, and if they are taken correctly. 

It clues medical history if the patient cannot provide the information, or potentially tell what is contributing to the patient’s condition.

Non-prescription medications can interact and affect the patient’s health and condition.

Medications can also alter (mask or worsen) clinical presentation of conditions or injuries, complicating assessments and condition management.

Some medications can worsen medical conditions or injuries, potentially turning the patient into a critical one.