EMT Rotations Test Flashcards (Most of the things we have learned, starting from chapter 1 to chapter 23)

Blood flow

Vena cava

superior/ inferior vena cava

Right Atrium

Tricuspid valve

Right Ventricle

Pulomonary valve

Pulomonary Artery

Lugs

Pulmonary veins

Left Atrium

Bicuspid valve

Left ventricle

Aortic valve

Aorta

Arteries

Arterioles

Capillaries

Venules

Veins

Vena cava

Cardiac Muscle Properties

• Contractillity

• conductivtiy

• Excitability

• Automaticity

A1, A2, B1, B2 Properties

• A1: Vasoconstrictor, constricts those smooth muscles, also increases sweat production

• A2: Medorates A1

• B1: Increases heart rate and contractility

• B2: Bronchodilator

Skin Layers

• Epidermis (outer layer, protects from infection, keeps everything in, temperature regulation)

• Dermis: Middle layer. Has blood vessels, hair follicles and sweat glands

• Subcutaneous fat: Fatty tissue

Cardiac electrical Conduction System

SA Node: 60-100 Bpm

AV Node:40-60 Bpm

Bundle of His / Av bundle

Purkinje Fibers:20-40 Bpm

Tidal volume

Amoutn fo air inhaled in one breath, usually 500 ml

Subtract dead space (150ml) so in total leaves PT with 350ml of O2

Upper Airway

• Nares (Where air is filtered, purified and warmed)

• Nasopharynx

• oropharynx

• pharynx

• Larynx

Lower Airway

• Larynx

• Trachea

• Carina divides the trachea into bronchi

• Bronchi

• Bronchioles(Smalll)

• Alveoli

RUQ

• Most of the liver

• Part of the pancreras

• Gallbladder(helps process fats)

• a bit of the small intestine(Duodenum, jejunum, illeum)

• kidney

LUQ

• Stomach

• Spleen

• small intestine(other half)

• The other half of the pancreas

• Kidney + adrenal gland

RLQ

*Small intestine

• large intestine

• If female then ovaries & reproductory parts

LLQ

• Small itnestine

• Large intestine

• Female reporductory parts/organs

Major pulses

• Carotid= Neck

• Radial= Thumb side of wrist

• Brachial=Biceps

• Femoral'=Inner thigh cose to abdomen

• posterior tibial= near the tibia

• Dorsalis pedis= feet

Pulse range

Adults: 60-100

Composition of blood

• Plasma:Fluid volume, has salts & proteins

• Platelets: Aid with clotting

• Red blood cells: Crry O2 Co2

• White blood Cells: Help fight infection

Compostion of ambient air

O2= 21%

Nitrogen=79%

Argon=.9%

Co2=.3%

Hypoxic drive

• The retention of CO2 in arterial blood= poor gas exchange

• Central chemoreceptors become insensitive to he changes that syimulate ventilation

• Peripheal chemoreceptors of then take over as the primary stimulus for ventilation

• body is reliant on a decreased O2 level

Hypercarbic Drive

Primary stimulus to breathe.

• too much CO2 in the blood

• Chemoreceptors detect ph, O2 lvls and Co2 in the blood and CSF

Minute Ventilation

Amount of air moved Ina dn out of the lungs in one minute

Calculating by multiplying Tidal Volume X Frequency

V/ Q Ratio

Hypoxemia

Low O2 in arterial blood

cuases:

• V/Q mismatch( a lack of oxygenated air in the alveoli)

• Anemia

• CO poisoning

Hypoxia

Low O2 content in blood

Due to many causes :

• Occluded airway

• inadequate breathing

• hypoperfusion

• Shock

• Inhalation of toxic gases

• Lung and airway disease (Asthma & emphysema)

• stroke

HYpoxia signs

• Tachypnea

• Dyspnea(SOB)

• PCC

• Tachycardia

• High Blood pressure

• Restlesness and agitation

• Headache

• Cyanosis(Severe hypoxia)

• AMS

• Seizure

• Sleepy appearance

Usea BVM

Snoring

• when upper airway is obstructed by tongue or pharynx tissue

• Tx:

• Head tilt, chin lift (no Spinal injury)

• Jaw thrust(Suspected Spinal injury)

Crowing

When the larynx muscles narrow and spasm

Gurgling

• INdicates the prescence of blood, secretions, Vomit & other liquid in Airway.

• Tx: Suction

Stridor

Due to selling in the larynx, can also be heard due to mechanical obstructions (food & others )

Suction

Suction when any liquid is present(Blood, secretions, Vomit, etc…)

If equipment is not available, and there is thick or solid objects you may perform a finger sweep.

• Place patient on their side and do a finger sweep

OPA

Directions

Only use if PT is unresponsive and has no gag or cough reflex

NPA

• can/ is used when PT does not tolerate an Opa, has clenched teeth, bititng or injuries to the maxilla.

• CNA be used in a PT who is no fully unresponsive, nrrfd assistance, and has a minimal gag reflex

Respiratory Arrest

Happens when PT Completely stops breathing , no rate or tidal volume

Causes:

• Stroke

• MI

• Drug overdose

• Suffocation

• Head, spine, chest or abdomen Injuries(traumatic)

• Epiglotis infection

• Foreign body obstruction

Agonal respirations

Gasping breaths.

Ineffective respirations

Use a BVM

BVM

if connected to reservoir do (15lpm)

Adult with a pulse: Once every 5-6 seconds

Infants/Children: ONce every 3-5 seconds

CPAP

Applied typically to patients with respiratory disease or cardiac failure

IS effective if there is liquid in the lungs.

• Asthma, CHF, Pneumonia, COPD, Pulmonary edema

Indications:

• Pt must be Alert & oriented

• Pt must be able to maintain own airway

• Has a resp rate above 25

Contraindications

• Apnea, agonal respirations

• Cant maintain their own airway

• Unresponsive

• Vomiting cosntantly

• Tracheotomy

• Facial trauma

NRB

Typical O2 rate is 15lpm

this delivers high concentration oxygen

NC

The rate is NO less than 1lp and no more than 6lpm

Shallow Respirations

Slight chest rise, minimal breaths , uses chest myo

Labored Respirations

Pt works hard to breathe , usually accompanied by an abnormal sound

Kussmaul Repsirations

A rapid respiratory rate with a deep and labored tidal volume

Seen in diabetic/metabolic emergencies

Irregular pulse

Irregular intervals, related to cardiac disease

Paleness

Sing of :

• Vasoconstriction

• blood loss

• Shock

• MI

• Anemia

• Syncope

• Emotional distress

• Hypoxia

• Hypoxemia

Blue-gray Skin

Indicates inadequate perfusion

Signs of:

• HYpoxia

• Hypoxemia

• MI

• Poisoning

Flushed skin

Might be a sign of heat exposure, peripheal vasodilation, or CO poisoning

Jaundice

Indicates liver disease

Mottling

Discoloration in a blotchy pattern

Often seen in Shcok patients or Patiens with blood pooling in extremities for long periods of time.

Systolic pressure

The amount of pressure on the arteries(their walls) during contraction and ejection of blood form the left ventricle

Diastolic Pressure

The amount of pressure in the artery when the ventricle is not contracting(at rest)

Pulse pressure

The difference between the systolic pressure and the diastolic pressure

Ex: 120- 80= 40

SAMPLE

S: Signs and Symptoms

A:Allergies
M: Medications
P: Pertinent Past history
L:Last oral intake
E:Events leading to injury/illness

OPQRST

Patient assesment

O: Onset (How fast)

P:Provocation/Palliation(What makes it better/worse)

Q: Quality( Can you describe the pain?)

R:Region, Radiation(Where? Does the pain go to a different place?)

S: Severity (pain scale 1-10)

T: Time(How long?)

53ABC

5:

• PPE and Scene safety

• MOI and NOI

• # of patients

• Additional help

• C-spine? and Threats

3

• General impression(Sick not sick)

• Alert and oriented

• Chief complaint

A: Airway(OPA & NPA)

B: breathing (Rate, rhythm, Quality), Intervention (CPAP, NRB, NC, etc)

C: Circulation (Rate, rhythm, Quality) any bleeding, skin tone, HR

Aspirin

Indication: Chest Pain

Action: Antiplatelet ( not clotting)

Dose: 324mg or 4 baby aspiring (81mg) in a 24 hour period

Route: buccal/Oral

Form: Tablet

Contraindication: Absolute allergy, TBI, GI bleed

Epinephrine

Indication: Anaphylaxis(low BP or closing airway)MD

Action: Vasoconstrictor, bronchodilator

Dose:.3mg Adults or .15mg peds

Route: Intramuscular

Form:Liquid

Contrindication: High blood pressure

MDI

Indication: Asthma, CHF, SOB

Action: Bronchodilator

Dose: 4-6 puffs every 5 minutes

Route: Inhaled

Form:Powder

Contraindication: not patients MDI

Activated charcoal

Indication: Ingestion of solid Poison

Action: Binds to poison

Dose:1g/kg

Route: oral

Form:Slurry

Contraindication: Pt has digested a liquid or acid/alkali poison

Narcan

Indication: Opioid overdose With resp depression

Action: Opiod antagonist Binds to Opiod receptor site

Dose: 2-4 mg

Route: Inhaled

Form: Liquid

Contraindication: Adequate respiratory rate

Glucose

Indication: Low blood sugar

Action: Increases BGL, promotes insulin secretion

Dose: 15mg or oe tube

Route:Buccal, Between cheek and gums

Form:Ampoule or paste

Contraindication: Patient is unresponsive, or can’t chew

Shock

when inadequate amouts of oxygen and glucose are delivered to cells

Hypovolemic Shock

Caused due to low blood volume '

Most common cause is hemorrhage

S/S

• PCC

• Rapid pulse and RR

• Low BP

• Thirst, dizziness

Distributive Shock

Due to decreased intravascular volume ( systemic vasodilation) and leaky capillaries

These cause a decrease in tissue perfusion

Poor cirulation

S/S

• Warm/Flushed skin

• Low BP

• fast HR

• Confusion

• Anaphylaxis if (anaphylactic shock), hives, swelling, SOB

Cardiogenic Shock

Ineffective pump function of the heart

ineffective contraction

related to Heart failure, MI, Arrythmias

S/S

• Chest pain

• Low BP

• SOB

• PCC

Obstructive Shock

Obstruction of forward blood flow

Pulmonary embolism, cardiac tamponade, tension Pneumothorax

S/S

• SOB

• Chest pain

• low BP

• JVD

• Rapid Pulse

Metabolic or respiratory shock

O2 cant diffuse into blood

Hemorrhagic Hypovolemic shock

Blood loss form trauma (organ, tissue etc)

Non Hemorrhagic shypovolemic shock

Fluid from red blood cells lost(Leaky capillaries)

causes (diarrhea, vomiting, excessive sweating, polyuria)

Burn shock (non Hemorrhagic)

burns mess up with the integrity of capillaries y vessels, and allows them to leak plasma,

Anaphylactic shock (distributive shock)

• leaky capillaries(edema) loss of fluid

• Low BP

Septic Shock(distributive)

Due to he body response to sepsis*infection), it causes sever vaso dilation, making thing leaky and loss of fluid and inadequate perfusion

Neurogenic shock( Distributive)

Spinal injury

S/S

• Low BP

• Brady cardiaa

• Warm fry and Flushed skin'

• Hypothermia

• weak pulse

Cardiogenic shock

Due to CHF or MI

(heart cant pump properly)

S/S

• Low BP

• Weak rapid pulse

• chest pain

• SOB

• PCC

• Pulmonary edema

• crackles

• pink forthy sputum

Compensatory Shock

S/S

• Normal BP

• fast RR

• PCC
  Anxiety

• delayed capillary refill

Decompensatory Shcok

Body cant maintain Bloos pressure

S/S

• Low BP

• AMS

• Weak or absent peripheral pulses

• fast or slow HR

• Poor urine output

• Cyanosis

Downtime

The time when PT gois into cardiac arrest until CPR starts

Total Downtime

Form Pt being into cardiact arrest, to CPR being administered to ROSC being back

Return of spontaneous circulation(ROSC)

When PT regains circulation during Resucitation

Survival

Pt who survives and is discharged from hospital

If Pt dies then it is not considered survival

Witnessed cardiac arrest

when EMTS see Pt become pulse less unresponsive, going into cardiac arrest

Unwitnessed Cardiac arrest

When EMT arrives at scene and PT is unresponsive, apneic, pulse less

Asthma

Bronchospasm narrows bronchia and bronchioles + inflammation In airway lining

Pneumonia

Actue Infection

Causes inflammation in the lungs

and pus/fluid filled alveoli

S/S

• Fever

• Tachypnea

• cough

• Chest pain

• Crackles

• Diaphoresis

• Cyanosis

Pulmonary Embolism

Due to a blood clot, or particle

Prevents blood from going to the lungs= limited oxygenation

S/S

• Sudden onset of Dyspnea

• Shapr stabbing chest pain

• Tachypnea

• Syncope

• Cough

• PCC

• Anxiety, sense of doom,

• Hypotensions

Pulmonary Edema

Cardiogenic related

non cardiogenic= destruction of capillary bed, vomit was aspired, pneumonia , Narcotic overdose, Inhaltion of smoke etc

S/S(cardiogenic)

• Dyspnea

• SOB when laying down

• Tachycardia

• Pink forthy sputum

• Crackles

• cyanosis

• PCC

• Tripoding

Pneumothorax

when a small portion of the visceral lining ruptures

The more they breath the more air gets trapped in between the Pleural lining and the visceral Wich will then lead to the lungs collapsing due to an increase in pressure

S/S

• Sudden Onset of SOB

• Decreased or absent lung sounds

• Sharp chest pain or shoulder pain

• Subcutaneous emphysema

• Tachypnea

• Diaphoresis

• Cyanosis

Hyperventilation Syndrome

PT is often anxious, feeling of not being able to catch breath, They breath faster and deeper

Blow off CO2 due to rapid breathing, (we need a certain AMT of CO2)

S/S

• Fatigue

• Nervousness or anxiety

• Dizziness

• SOB

• Chest tightness

• Tachypnea

• Finger spasms

• Tachycardia

Epiglottittis

Inflammation for the epiglottis

A real emergency when ti comes to childre

S/S

• tripoding

• fatigued

• Anxious

• Cyanosis

• Can barely speak

Pertussis

• whooping cought

• uncontrolled coughing

• Mostly in children

S/S

Sneezing

vomiting

Malaise

Sever coughing

Stroke

Neurologic Deficit, a deficit int he Nervous system or brain , associated with lack of o2 and glucose, related to a clot

Fast

F-Facial Droop

A- Arm weakness

S- Slurred speech

T- Time to call 911

Ischemic Stroke

Caused by a blockage, when an artery is blocked due to a clot or other object

often happens when patient is awake and aware

Hemorrrhagic

Caused due to rupture and bleeding

Bleeding within the brain

can be due to an aneurysm

or an arteriovenous malformation(super rare)

S/S

• Head ache

• nausea and vomiting

• Weakness on one side of the body

• AMS

• Intolerance to light

TIA(Transient Ischemic attack)

a brief blockage for Blood flow to the brain

its a sign that a stroke is coming

Similar signs, but are temporary

SIgns of a Circulation Stroke

• paralysis or motor deficits

• Numbness, tingling, loss of sensation

• language disturbances, bable, or they understand you but have trouble respoding

• The don’t understand you and repsond in fluent words that a rubbish

• Vision loss/ distrubance

• Eye gaze

Cryptogenic Stroke

Cant be attributed to am embolism

has different causes than an embolism

Insluin

Secreted when the BGL is High

Beta cells in pancreas produce insullin

Glucagon

Secreted when BGL is low

Alpha cells Produce Glucagon in Pancreas

Hypolgycemia

Low BGL

Hyperglycemia

High BGL