NREMT STUDY GUIDE (AEMT) with 100% correct answers already graded A+(verified for accuracy)

Upper Airway Anatomy

nasopharynx

nasal air passage

pharynx

oropharynx

mouth

epiglottis

larynx

Lower Airway Anatomy

trachea, bronchioles, main bronchus

Tidal Volume

amount of air moved in or out of lungs in 1 breath

Residual Volume

The air that remains in the lungs after maximal expiration.

Alveolar Ventilation

the volume of air that reaches the alveoli

dead space minus tidal volume

Dead Space

portion of tidal volume that does not reach alveoli, does not participate in gas exchange

Minute Volume

volume of air moved through lungs in 1 minute

tidal volume times RR

Atelectasis

alveoli collapse due to inadequate amount of surfactant

External Respiration

process of breathing fresh air into resp. system, exchange of O2 and CO2 in lungs and alveoli

Internal Respiration

exchange of gases between circulatory system and rest of body's cells

Neural Control

comes from the Brain, specifically medulla oblongata and the pons

connected by vagus nerve

medulla oblongata

controls Rrate, depth and rhythm

Pons

the part of the brainstem that links the medulla oblongata and the thalamus

secondary control center

sleep and arousal

Chemical Stimuli

comes from chemoreceptors which monitor variables and give feedback to the brain to modify RR ad depth

central chemoreceptors

located in the medulla

monitor pH of CSF

sensitive to small changes in pH balance

peripheal chemoreceptors

located in carotid bodies and aortic arch

measure amount of CO2 in arterial blood

Hypoxic Drive

secondary system to control breathing

V/Q

ventilation/perfusion ratio

V/Q mismatch

contributes to most abnormalities in O2 and CO2 exchange

Hypoventilation

buildup of CO2

can indicate acidosis (low pH)

Hyperventilation

eliminates CO2 from body

can indicate alkalosis (high pH)

Adult Normal RR

12-20/min

Children Normal RR

12-37/min

Infant Normal RR

30-53/min

Cheyne Stokes

rhythmic, gradually increasing rate and depth, followed by gradual decrease in both with periods of apnea

Brainstem injury

Kussmaul

deep, rapid labored breathing seen with DKA

Biot

irregular pattern, rate and depth with intermittent periods of apnea (Increased ICP)

Apneustic Breathing

prolonged gasping followed by ineffective exhalation

seen with brainstem injury

Agonal Gasping

slow, shallow, irregular breathing; heart may have stopped but brain still sends signals (end of life)

OPA

measure from edge of mouth to ear

Use for unresponsive, no gag reflex, BVM

Do not use for responsive and/or gag reflex

NPA

measure from nostril to ear

Use for AMS, gag reflex, when OPA not tolerated

Do not use for facial trauma, basilar skull fx, resistance upon insertion

Nasal Canula

1-6LPM

21-44%

Partial NRB

10-12LPM

60-80%

NRB

10-15LPM

80-100%

BVM

15-25LPM

100%

King Tube

supraglottic BIAD

Inserted into esophagus, balloons inflated to seal off it and oropharynx

Adult or Child Sized

Use for unresponsive, no gag reflex and/or apneic patients

Do not use with gag reflex, ingestion of caustic substance or esophageal disease

LMA

supraglottic BIAD

Surround opening of larynx with inflatable cuff, sits in hypopharynx at the glottic opening

Same uses as King Tube

Less effective in Obese and COPD

Sizes based on weight

Protects against soft tissue damage and dental trauma

I-Gel

supraglottic

similar to LMA

avoids compression trauma of airway

Combitube

Multilumen BIAD, alternative to intubation

Can be used to ventilate

Use for deep unresponsiveness, no gage reflex, ET not possible, unsuccessful

Do not use for patients under 16yrs, esophageal disease, alcoholism or ingestion of caustic substance

Sizes based on height

Compression depth

2-2.4inches

SA node

Right Atrium

fires at 60-100bpm

AV node

fires at 40-60bpm

Purkinje Fibers

fires at 20-40bpm

Left Atrium

receives oxygenated blood from the lungs via pulmonary artery

Right Atrium

Receives deoxygenated blood from the body

Right Ventricle

pumps to pulmonary vein

Left Ventricle

pumps blood to aorta

Systole

Contraction of ventricular mass

Diastole

relaxation, blood fills chambers

Afterload

pressure in aorta that the L ventricle must pump against

Preload

pressure under which the ventricles fill

Stroke Volume

amount of blood ejected with one contraction

Cardiac Output

amount of blood pumped throughout the circulatory system in one system

SV*HR

Starling Law

increased venous return to the heart stretches the ventricles, resulting in increased contractility

Ejection Fraction

% amount of blood heart pumps out

Red Triage Tag

ABC compromised, severe bleeding, shock, severe burns, open chest/abdominal injuries

Yellow Triage Tag

burns w/out airway compromise, multiple bone injuries, back injuries w/out spinal cord damage

Green Triage Tag

walking wounded

Black Triage Tag

obvious death/cardiac arrest

START Triage

weed out walking wounded, get to first patient who can't walk, open airway (RED if works, BLACK if not), asses radial pulses (RED if none), commands (RED can't follow, YELLOW can)

JumpSTART Triage

8yrs old or younger or under 100lbs

If pulsed open airway, give 5 breaths (unsuccessful=BLACK)

inadequate RR =RED

NO Pulse=RED

Neurologic Status= AVPU (YELLOW,YELLOW,RED,BLACK)

ICS

command, finance, logistics, operations and planning

Command Staff

consists of safety officer, public info officer, joint info center for evacuation directions and liaison officer to relay messages

First Trimester

Last Menstrual Cycle-Week 12

Second Trimester

Week 13-27

Third Trimester

Week 28- term

Respiratory Problem with pregnant patients

uterus lies against diaphragm, increased RR leads to excess CO2 blow off=alkalosis causing SOB

Peristalsis

Involuntary waves of muscle contraction that keep food moving along in one direction through the digestive system.

Stage 1 Labor

onset of contractions to full cervix dilation

Stage 2 Labor

crowning to fetus delivery

Stage 3 Labor

delivery of fetus to delivery of placenta

Spontaneous Abortion

miscarriage

most common cause of bleeding in 1st and 2nd trimester

Give 250ml blouses of NS, NRB@15LPM, treat for shock, IV access, fundal message helps with delivery

Ectopic Pregnancy

growth of fetus in fallopian tube, on the ovary or abdominal cavity/peritoneum

lower abdominal pain, bleeding

treat for shock

Abruptio Placenta

placenta separates from uterine wall

common in 3rd trimester

risk factors are HTN, trauma, drug use, multiple pregnancies

abdominal pain radiates to back

little bleeding, dark

treat for shock

Placenta Previa

placenta implanted low in uterus, obstructs cervical canal

leading cause of bleeding in 2nd and 3rd trimesters, usually near term

risk factors are maternal age and multiple pregnancies

abdominal pain radiates to back with painless bright red bleeding

treat for shock

Chronic Hypertension

>130/80

prior to 20th week of gestation or post partum

can alter fetus growth, renal fialure, pedema, seizures

Gestational Hypertension

Occurs after 20th week, resolves post partum

obese or glucose intolerant patients

Preeclampsia

increase in bp after 20th week

risk factors are younger than 18 w/first pregnancy, 35yrs and up, chronic HTN, renal disease, diabetes

edema in face, hands and ankles, weight gain, visual disturbances

Eclampsia

seizure with patient that has preeclampsia and no other reason for seizure

can happen at any point of gestation

post partum eclampsia occurs 24hrs after birth up to 4 weeks after

supine hypotensive syndrome

2nd and 3rd trimesters

compression of Vena Cava

s/s onset 3-7minutes, N/V, tachycardia, claustrophobia, SOB, syncope

position in left lateral

Gestational Diabetes Mellitus (GDM)

inability to process carbohydrates/insulin

need hypoglycemic meds

can cause baby to grow too big or develop hypoglycemia

usually resolves following delivery

hyperemsis gravidarum

pregnancy related vomiting containing bile and blood, pallor and jaundice

Uterine Rupture

a tear in the wall of the uterus

usually caused by trauma

s/s tender abdomen, easily palpable fetus, abnormal fetal position, bleeding, inability to palpate top of uterus

treat for shock, maintain bp above 80 systolic

Postpartum Hemorrhage

500ml of blood loss after birth

treat for shock

cephalopelvic disproportion (CPD)

a condition in which the fetal head is too large for the mother's pelvis

amniotic fluid embolism

An extremely rare, life-threatening

condition that occurs when amniotic fluid and fetal cells enter

the pregnant woman's pulmonary and circulatory system

through the placenta via the umbilical veins, causing an

exaggerated allergic response from the woman's body

Breech Delivery

buttocks present first, slow delivery

limb presentation

arm, leg or foot presents first

do not deliver in field

elevate hips, head down of mother

Shoulder Dystocia

head delivered, shoulder can't get past symphysis pubis

flatten back, hyperflex legs tight to abdomen, apply suprapubic pressure, gently pull on fetus' head

Nuchal Cord

15-34% of births

slip cord over head or cut once if unsuccessful

Prolapsed Cord

cord emerges prior to fetus out of uterus

push baby away from cord, keep cord in moist sterile dressing

Para gravida

how many births (P) how many successful births (G)

Grand multipara

woman who has given birth 5 or more times

Neonatal IV access

usually not needed

if needed, go for peripheral veins in antecubital fossa or saphenous veins anterior to medial malleolus at the ankle

Neonatal IO access

proximal tibia

Pediatric Triangle

Appearance, work of breathing and circulation to the skin.

pediatric appearance assessment

muscle tone, body position, AVPU/GCS

Pediatric Work of breathing assessment

visible movement, effort, sound, rate, central color

pediatric circulation assessment

color, bleeding, HR/strength, cap refill

Cerebellum

the "little brain" at the rear of the brainstem; functions include processing sensory input and coordinating movement output and balance