Final Review pdf OMI

Primary function of the respiratory system

Exchange of Oxygen and Carbon Dioxide

Primary muscle responsible for breathing:

Diaphragm

Normal Adult Respiratory rate :

12-20 breaths per min

During inhalation the diaphragm does what?

The diaphragm contracts

What happens to intrathoracic pressure on inhalation?

Intrathoracic pressure decreases

Describe the path of Oxygen during respiration

Mouth/Nose - Nasopharynx/oropharynx - larynx - trachea - bronchi- bronchioles- alveoli- blood

The most common cause of airway obstruction in the unresponsive patient

The tongue

To open the airway in a trauma patient, use the what?

Modified Jaw thrust

Adequate ventilation with BVM is confirmed by

Chest Rise

High-pitched inspiratory sound and its cause is?

Stridor ; partial upper airway obstruction

Indications for an Oropharyngeal airway (OPA)

unresponsive, no gag reflex

A nasopharyngeal airway (NPA) should not be used if you suspect

Facial/skull fracture

Proper OPA size is measured from the

Corner of mouth to the tip of the earlobe/angle of jaw

Proper NPA size is measured from the

Septum/tip of nose to the Tip of the earlobe/angle of jaw

Maximum Suction duration

Adult 15 sec

Pediatric 10 sec

Infant 5 sec

Nasal cannula delivers low flow and provides about how much oxygen?

1-6 L/min and provides about 24-44 % of oxygen

Nonrebreather delivers low flow Oxygen at what and And provides about how much oxygen ?

10-15 L/ min and provides about 90-99% of oxygen

Bag-valve mask (BVM) delivers low flow oxygen at ?

15 L/min and provides about 100% of oxygen

Ventilation is what?

The physical process of air moving in and out of the lungs

Oxygenation is what?

The process of loading oxygen molecules onto hemoglobin molecules in the blood

Respiration is the process of what?

The process of gas exchange; oxygen and carbon dioxide

Hypoxia is defined as

Low oxygen concentration in the tissues

Early signs of hypoxia include

Anxiety, restlessness, tachypnea, tachycardia

Signs of inadequate breathing in adults:

• Respiratory rate >20 or <12

• Irregular respiratory pattern

• Diminished,absent or noisy lung sounds

• Tripod positioning

• Reduced tidal volume

• Unequal chest rise Use of accessory muscles

• Cool, pale or cyanotic, clammy CTC

Describe the difference between wheezing, crackles, and stridor. What does each indicate: Wheezes

Caused by bronchospasm; indicates obstruction of the smaller airways

Describe the difference between wheezing, crackles, and stridor. What does each indicate: Crackles/Rales

Caused by fluid obstructing the alveoli; common in drownings and heart failure

Describe the difference between wheezing, crackles, and stridor. What does each indicate : Stridor

High pitched upper airway sound caused by partial obstruction of the airway

List 3 Conditions commonly associated with wheezing:

• Asthma

• Anaphylaxis

• COPD/Bronchitis

CPAP indications

Alert/able to foAlert/able to follow commands, moderate/severe respiratory distress, SpO2 less than 90%, Commonly used with patients presenting with rales

Remove CPAP immediately if?

Pt goes into respiratory arrest, patient loses ability to maintain their own airway, Hypotension less than 90 mmHg systolic, Vomiting

What things are evaluated during your general impression?

Patient's age, gender, position found, apparent level of consciousness

Explain the importance of trending vital signs. When is it MOST important?

Trending vital signs allow us to assess the interventions performed or general patient improvement or deterioration.

Define AVPU. Give an example presentation for each letter.

AVPU is used to assess the patients level of consciousness

A: Alert- patient eyes spontaneously open and interacting with environment

V: Verbal- Responds to verbal stimuli

P: Painful - Responds to tactical stimuli (Taps or trapezeus pinch/sternal rub)

U: Unresponsive - Responds to NO stimuli

Explain the difference between COMPENSATED and DECOMPENSATED shock

During compensated shock, the patient still has the ability to maintain perfusion despite the cause of the shock. Once the patient reaches decompensation, they are no longer able to perfuse the tissues and are unable to keep up with the cause of the shock, for example, blood loss.

List early signs of compensated shock

Anxiety Restlessness Tachycardia Dyspnea Tachypnea

Which type of shock is suspected when there's fever + altered mental status? Explain.

Septic shock (Distributive) - Widespread vasodilation due to infection. Most common sign is fever and altered mental status, especially in geriatrics

Obstructive Shock

Physical block causing pump failure

• Pulmonary embolism

• Tension pneumothorax

• Cardiac Tamponade

Cardiogenic Shock

Inadequate heart function,

• Pump failure

• Occurs commonly after Acute Myocardial Infarction (AMI)

Distributive Shock

Widespread dilation of the smaller vessels causing pooling of blood in the vascular beds

• Anaphylaxis - extreme allergic reaction

• Sepsis - Severe infection Neurogenic- High spinal cord injury

• Psychogenic- Temporary vasclar dilation commonly causes syncope

Hypovolemic Shock

Loss of blood or fluid

Bleeding (both internal and external)

Vomiting/diarrhea

Burns

Describe the Rule of Nines and estimate the % BSA for:

Entire head (adult): 9%

One full arm: 9%

One full leg: 18%

List three stroke warning signs that would appear during a BE-FAST/Cincinnati Stroke assessment:

Balance

Eyes

Facial Droop

Arm drift

Speech

Time

Explain the difference between postictal and actively seizing

1. The postictal phase of a seizure is the period after, usually lasting 5 to 30 min, characterized by labored respirations and altered mental status

2. Active seizing is generally characterized by severe twitching and stiffening of the body's muscles usually lasting less than 5 min

What is your FIRST priority when a patient is post-seizure but has gurgling respirations?

Priority is suction the airway and then oxygenation

Describe Cheyne–Stokes respirations. What condition are they commonly associated with?

Cheyne stokes are described as an irregular respiratory pattern in which the patient breathes with an increasing rate and depth of respirations that is followed by periods of apnea.

This is common in metabolic acidosis - Diabetic Ketoacidosis (DKA)

Why is aspirin given for suspected ACS? (Mechanism of action)

Aspirin is an anti platelet aggregator. It is given for suspected ACS in hopes to decrease the size of the clot or prevent it from growing.

Before assisting with nitroglycerin, what must you ALWAYS check?

Full set of vitals must be taken before nitro administration as well as inquiring about the use of ED medications.

What is the mechanism of action of nitroglycerin?

Nitroglycerin is a vasodilator, vasodilation puts less workload on the heart, decreasing ischemia and chest pain

List signs of pediatric respiratory distress

- Abnormal airway sounds

-Accessory muscle use

-Retractions

-Head bobbing

-Nasal flaring

-Tachypnea

-Tripod position

Describe the signs of dehydration in a child and what finding is MOST important.

Poor skin turgor

Dry mucus membranes

Altered mental status*

Explain the difference between placenta previa and abruptio placentae

Placenta previa is when the placenta develops over the cervical opening preventing natural passage of the fetus. -Presesnts with PAINLESS vaginal bleeding

Abruptio placentae occurs when the placenta prematurely detatches from the uterine wall -Presents with vaginal bleeding WITH severe abdominal pain

List two steps to take if a nuchal cord is present during delivery

First attempt to slip the cord over the baby's head Then if unsuccessful, clamp cord, palpate until loss of pulse, then cut.

Explain what the APGAR scale evaluates and when it is used.

APGAR is the scale used to assess a neonate. It should be performed AT LEAST 1 min after delivery and 5 min after delivery

Explain what the APGAR scale evaluates and when it is used.

APGAR is the scale used to assess a neonate. It should be performed AT LEAST 1 min after delivery and 5 min after delivery.

A Appearance

P Pulse

G Grimace or Irritability

A Activity or Muscle Tone

R Respiration

Describe DCAP-BTLS and what each letter stands for.

DCAP BTLS is what you are looking for when inspecting and palpating during a trauma assessment

Deformities- misshapen body part

Contusions - collection of blood under the skin ; bruising

Abrasions - loss or damage to the surface of the skin from rubbing or scraping

Punctures/Penetrations - A small hole through the skin into the soft tissue

Burns - Redness, blisters, or white areas of the skin

Tenderness - pain upon palpation

Lacerations - Deep, jagged cut through the skin

Swelling - Raised or enlarged area of the soft tissue on the surface of the skin

List signs of a tension pneumothorax.

- Severe shortness of breath

- diminished or absent lung sounds on affected side

-Decreased/altered level of consciousness

- Jugular vein distention (JVD)

- Tracheal deviation (late sign)

-Hypotension/Shock signs

Define a flail chest and explain the classic chest movement pattern

Two or more adjacent rib fractures in two or more places causing a segment of the chest wall to become detached from the rest of the thoracic cage.

Paradoxical motion is when the detached portion moves opposite of normal. ( It moves in instead of out during inhalation and out instead of in during exhalation)

Describe what an occlusive dressing is used for and when it must be applied.

An airtight dressing that protects a wound from air and bacteria. Used to seal holes in the chest, neck, and to seal evicerations.

What is the first step in START triage?

The first step in START triage is to call out to patients at the disaster site, "If you can hear my voice and are able to walk, come to x location." This separates your green (minor)/walking wounded.

What is the role of the incident commander at the scene of an MCI?

The incident commander (IC)'s role is to oversee the overall incident. They will assess the incident, establish objectives and priorities and develop a plan to manage the incident.

Explain why chemical burns to the eyes require immediate irrigation.

Chemical burns to the eyes can cause serious and permanent damage to the eye.

Immediate (Red)

First priority, patients who need immediate care and transport.

• airway and breathing compromise

- Uncontrolled bleeding

- Signs of shock

Delayed (Yellow)

- Patients whose treatment and transport can be temporarily delayed

-Burns without airway compromise

-Major or multiple bone or joint injuries

-Back injuries

Minor / Walking Wounded (Green)-

• Patients who require minimal or no treatment and transport can be delayed until last

• Minor fractures

• Minor soft tissue injuries

Expectant (Black)- Patients who are already dead or have little chance for survival

-Obvious mortal injury

-Respiratory/cardiac arrest

Hyperglycemia

a slower onset, patient will present with warm, dry skin as well as altered mental status

Which type of diabetes is more likely to lead to DKA?

DKA is the hyperglycemic emergency associated with Type-1 diabetes.

A patient is diagnosed as insulin-dependent at a young age and is prone to sudden hypoglycemic events. Which type of diabetes is this most consistent with, and why?

Diabetes Type 1. This is an autoimmune disorder in which the individual's immune system produces antibodies against pancreatic beta cells. The onset of this disorder usually happens from early childhood to the fourth decade of life.

List the four quadrants of the abdomen and one major organ in each.

RUQ:

Right Upper Quadrant - Liver and Gallbladder

List the four quadrants of the abdomen and one major organ in each. LUQ

Left Upper Quadrant - Stomach, Spleen, Pancreas

List the four quadrants of the abdomen and one major organ in each. RLQ

Right Lower Quadrant - Large Intestines, Appendix

List the four quadrants of the abdomen and one major organ in each. LLQ

Left Lower Quadrant - Small Intestines

Vena Cava

one of two large veins that return blood to the heart

Aorta

large artery, takes blood from the heart to the rest of the body

Artery

takes blood away from the heart

Left Atrium

pumps oxygen- rich blood from the body to the left ventricle

Veins

takes blood to the heart

Right Atrium

receives blood from the body and sends it to the right ventricle

Valves

structures through which blood passes. there are four in the heart

Left atrium

pumps oxygen - ruch blood from the body to the left ventricle

left ventricle

receives blood from the left atrium and pumps it into the body

septum

wall of muscle that seperates the right and left sides of the heart

Right ventricle

receives blood from the right atrium and pumps it into the lungs

Hyperglycemia

a slower onset, patient will present with warm dry skin and altered mental status

Hypoglycemia

a rapid onset, patient will present with cool clammy skin and altered mental status