DAANCE: all modules (copy)

Congestive heart failure

Condition caused by the heart is unable to handle blood volume coming back to it from either the lungs or peripheral circulation.

Nasopharynx

Located above back of soft palate.

Left ventricle

Pumps oxygenated blood to peripheral circulation via aorta.

Pulmonary artery

One of two arteries that carry venous (oxygen poor) blood from heart to lungs

What type of intubation is preferred with emesis with aspiration?

ETT. LMA or combitube acceptable.

Facial artery

Supplies blood to face, tonsil, palate, and submandibular gland.

Rate of ventricles

20-40

Arrest rhythms

Ventricular dysrhythmias

Rate of SA node

60-100

Review of systems cardiovascular

Headaches, dizziness, nosebleeds, shortness of breath, chest or arm pain, edema.

Dyspnea

Difficulty breathing or breathlessness.

Diabetes mellitus

Metabolic impairment where the body is unable to metabolize glucose properly causing increased blood glucose levels. This prevents the body from metabolizing carbs properly.

Considerations for diabetic patients

Patients with diabetes do not heal as quickly and are more prone to infection. Often placed on antibiotics.

Unmodifiable risk factors for stroke

Male, age 55 or older, two times African American, previous stroke, heredity.

Considerations for obese patients

Use of a large blood pressure cuff, difficult venous access, patients should be treated in upright or semi fowler position.

Lower airway

Trachea, bronchi, lobular bronchi, bronchioles, and alveoli.

Peripheral nervous system

Consists of sensory and motor nerves.

Tidal volume

Normal breathing 500 cc of air is inhaled and exhaled.

Neurons

Nerve cells

Sensory nerves

Receive messages from environment and and conduct messages back to CNS.

Brain stem

Pons, medulla oblongata, midrain

Accessory muscles of respiration

Sternocleidomastoid, scalenes, abs which are most important.

Erythrocytes

Red blood cells

SA node

Located in right atrium. Acts as pacemaker. Produces sinus rhythms.

Treatment for mild allergic reaction

Place patient in upright or reclined position, 100% O2, monitor vitals, Benadryl

Treatment for seizures

IV access, Valium 5mg IV or medazolam 3mg, continue to monitor vitals, activate EMS

Treatment of hypoglycemia

Activate EMS, IV access, measure blood sugar with glucometer, 1 amp of glucose, IV infusion of dextrose or glucogan IM if no IV

Propofol

Mimics barbiturates. Rapidly redistributed and metabolized due to being highly bound to fat.Does not tend to predispose to laryngospasm and has antiemetic properties. Discard after 12 hrs.

MONA

Morphine, oxygen, nitroglycerin, aspirin

Symptoms of heart attack

Chest pain, anxiety, weakness, sweating, cardiac dysrhythmias, drop in blood pressure.

Black

Nitrogen

Halogenated hydrocarbons

Inhalation agents that come in liquid form and are poured into vaporizers that allow for controlled evaporation and release for administration of gas. Sevoflurane, desflurane, isoflurane.

Steroids

Prevent swelling by stabilizing cell membranes and also prevent acute adrenal deficiency and nausea. (Decadron, solu medrol, solu cortel)

Volume of one carpule of local anesthetic

1.7 mL
Mg/cc * 1.7 to get concentration.

Drug reversal agents

Narcan and flumazenil

Anxiolytics

Benzodiazepine family of meds. Cause increased pressure in eye and should be used with caution on patients with glaucoma.

Narcotics

Provide systemic pain control. Respiratory depressant and potential for addiction. May produce drowsiness, euphoria and hypotension. (Morphine, Demerol, fentanyl, remifentanil)

Demerol

Same pharmacological effects as morphine.

Narcotic agonist antagonists

Standard narcan. Narcotics reversible with drugs that antagonize effects. All relieve pain and provide some degree if sedation. (Narcan, talwin, stadol).

Symptoms of stroke

Paralysis, localized weakness, headache, numbness, slurred speech, inability to speak (aphasia), memory loss, dizziness, blindness to one eye, confusion, loss of consciousness, double vision, ataxia.

Symptoms of syncope

Syncope is a loss of consciousness due to sudden sharp, transient drop in blood pressure. This is caused by the shunting of blood flow to extremities by sympathetic nervous system which causes blood to pool in extremities decreasing blood flow to brain. Symptoms include diaphoresis, pallor, nausea, light headedness, and tachycardia

What emergency would a cricothyrotomy typically be performed?

Airway obstruction

Atropine would be given in which emergency?

Symptomatic bradycardia

Adenosine would be given in which emergency?

SVT

Amiodarone would be given in which emergency?

V. Tach

What medications can be given for a sever case of hyperventilation?

Versed, Valium, or Propofol

PVC's are treated with which medicine?

Lidocaine

Epi is given in which two emergencies?

V. Fib and asystole

Max dose of epi for cardiovascular disease pt

.04mg

A beta blocker would be given in which emergency?

Hypertension

A fluid bolus of NS and ephedrine can be given with what emergency?

Hypotension

What medications are used to treat malignant hypothermia?

Dantrolene, IV cold saline (not Ringer's)

Nasopharyngeal airway

When tongue is obstructing airway. Tube is lubricated and passed through the nose into nasal cavity. Sits in oropharynx behind tongue. Well tolerated and can be used on awake pts.

Oropharyngeal airway

Also placed to position tongue in more anterior position. Often interfere with intra oral procedures. Not tolerated well with awake pts.

Laryngeal mask airway (LMA)

Device that sits over top of larynx. Can be placed blindly. Does not protect against aspiration. Inflated with 30cc to create seal.

Endotracheal intubation

End of tube passes through vocal cords and terminates half way between vocal cords and bifurcation of trachea. Important to listen to both lungs after placement. May or May not be cuffed.

Combitube

Generally used for specific emergencies. Both cuffs inflated.

Pts predisposed to bronchospasm

Allergies, asthma, copd, bronchitis

Bronchospasm

Generalized contraction of smooth muscles of small bronchi and bronchioles in lungs causing restriction of air flow of air to and from lungs.

Maximum dose of epi for healthy pt

.2mg

Liver

Protein and lipid synthesis, bio transformation, detoxification and storage of vitamin A, E, D, K, and B12.

Causes of seizures

Liver failure, renal failure, sickle cell disease, brain tumor, meningitis, previous stroke and hypo-hyperglycemia.

Medications to treat seizures

Tegretol, Klonopin, Neurontin, luminal, Dilantin, depacon

Main function of kidneys

Maintain volume and composition of body fluids. Body's main source of filtration and excrete metabolic end products and toxins.

Islets of langerhans

Located in pancreas. Secrete insulin and glucagon. Insulin helps the body store sugar to keep glucose levels in a steady state.

Adrenal glands

Secretes epinephrine and norepinephrine. Controls electrolyte balance and carb metabolism.

Thyroid

Regulates body's basal metabolic rate.

Pterygoid plexus

Network of veins corresponding to 2nd and 3rd parts of maxillary artery

Olfactory nerve

1st cranial nerve that controls smell

Optic nerve

2nd cranial nerve that controls sight

Internal jugular vein

Drains much of blood from head and neck

Purkinje fiber system

Causes muscles of heart to contract. Spreads impulse rapidly along heart muscle.

Brachiocephalic artery

Branches into right common carotid in neck and right subclavian artery in arm.

Hematocrit

% blood volume made up of red blood cells. Men: 42-52% women: 37-48%. Anything below 35% considered anemic.

Mental artery

Supplies blood to chin.

Ischemia

Reduced blood flow in coronary arteries. Lack of oxygen to heart cells weakens, but does not kill them.

Maxillary artery

Supplies blood to maxilla, teeth, sinuses, and portion of nose.

Medulla oblongata

Coordinating region for impulses. The seat of many autonomic centers.

Normal levels of hemoglobin

Males: 13-18 mg/dL
Females: 14-16 mg/dL

Oropharynx

Located between soft palate and epiglottis.

Facial nerve

7th cranial nerve. Supplies motor fibers to muscles of facial expression.

Trigeminal nerve

5th cranial nerve. Supplies sensation to teeth and jaws.

Vagus nerve

10th cranial nerve. Supplies fibers to many parts of body. (Ears, tongue, pharynx, larynx, thoracic/abdominal viscera).

Pulmonary veins

Return oxygenated blood to left atrium from lungs. Only veins that carry oxygenated blood.

Superior vena cava

Drains head, neck, and upper extremities into right atrium.

Adrenal glad

Secretes epinephrine, norepinephrine, and corticosteroids.

Ectopic focus

Displaced central point of origin for cardiac dysrhythmias.

Inferior alveolar artery

Supplies blood to teeth, mandible, lower lip, and chin.

Inferior vena cava

Drains lower extremities and abdominal viscera into right atrium.

Brachial artery

Supplies blood to shoulder, arm, forearm, and hand.

T's of pulseleas electrical activity

Toxins, trauma, thrombosis, tension pneumothorax, tamponade

H's of pulseless electrical activity

Hydrogen ion, hypoxia, hypovolemia, hypoglycemia, hypo/hyperkalemia, hypothermia.

Pulseless electrical activity (PEA)

Normal appearing tracing, but patient has no pulse.

Asystole

Cessation of all contractions. "Flat line" usually follows v. fib or v. tach. Treated with CPR.

Ventricular fibrillation v. fib

Course v. fib with prominent, erratic baseline or fine v. fib with far less pronounced vacillations. No p, qrs, or t. Often precedes asystole.

Class III

Pt has severe systemic disturbance or disease.

Class IV

Patient has a severe, life threatening systemic disorder.

Class V

Patient is moribund with little chance of survival. Surgery is done in desperation.

Class II

Patient has mild to no systemic disturbance. Smokers included.

Class I

Patient has no organic, biochemical, psychiatric, or physiological disturbance.