EMT - Final Exam - Ch. 1-41

glucose is used for the building of _____, the basic nutrient and energy for a cell

ATP (adenosine triphosphate)

aerobic respiration produces wastes that cause the body to form _____

acids - essentially all waste is managed and removed from the body

anaerobic respiration produces what

lactic acid (from pyruvic acid)

what process moves oxygen across the membrane from the alveoli to the capillaries

diffusion

the removal of _____ _____ helps regulate acid levels in the body

carbon dioxide

effects of the release of epinephrine and norepinephrine

dilation of bronchial tubes, more efficient gas exchange, faster heart rate/cardiac output, some constriction of blood vessels to non-essential organs (regarding flight or fight response)

how much nitrogen and oxygen is in inhaled air

79% nitrogen ; 21% oxygen ; very low % other gases

FiO₂ refers to fraction of inspired oxygen, what is this

the concentration of oxygen in the air we breathe

a patent airway is a(n)

open, non-obstructed airway

tidal volume

the amount of air moved in ONE cycle of breathing

minute volume

tidal volume (air breathe in) * number of respiration’s per minute = the amount of air moved in a minute

dead air space refers to the

air that occupies the space between the alveoli and mouth, but DOES NOT take part in gas exchange

three types of respiratory dysfunctions

disruption of: respiratory control, pressure, and lung tissue

disruption of respiratory control

effects on the medulla oblongata (strokes, drugs, toxins, trauma, etc.) that cause the medulla oblongata to effectively regulate respiratory control and tidal volume

disruption of thoracic pressure on respiration

affects the negative pressure created in the thoracic cavity needed to adequately provide ventilations (blood/fluid, air accumulation due to trauma can cause collapsed lungs and a decrease in adequate pressure)

inhalation is a _____ process, creating _____ pressure, thus forcing air into the lungs

active ; negative

exhalation is a _____ process, creating _____ pressure, thus forcing air out of the lungs

passive ; positive

changing pressures changes for proper respiration relies on an intact _____ _____

thoracic (chest) compartment

disruption of lung tissue

when lung tissue is displaced or destroyed via mechanical force, causing ineffectiveness in gas exchange (particularly that of the alveoli membrane)

what medical problems commonly causes disrupt the ability of alveoli to transfer gases across its membranes, leading to hypoxia and hypercapnia

congestive heart failure (CHF) and sepsis

hypoxia

low oxygen levels within the body

hypercapnia

high carbon dioxide levels within the body

chemoreceptors send messages to the brain to increase __________

rate and/or tidal volume

plasma oncotic pressure

pulls water back into the bloodstream from surrounding tissues (albumin protein in blood plasma) is the biggest contributor)

hydrostatic pressure

pushes water out of the vessels and into the interstitial space between cells

plasma makes up _____ , erythrocytes make up _____ , and luekocytes make up _____ of total blood volume

54% ; 45% ; 1%

blood vessel dysfunctions

loss of tone, excessive permeability, hypertension, loss of regulation

loss of blood vessel tone

inability of blood vessels to control their diameter. Uncontrolled vaso- dilation or constriction that can lead to drastic pressure changes within the blood vessels themselves

what is excessive permeability in relation to blood dysfunction

when blood vessels, caused by certain conditions, allow to much fluid to flow out through their walls

leaky capillaries may lead to

volume loss from the bloodstream

increased permeability in the lungs can cause

plasma to cross the membrane and occupy space around the alveoli, causing disruptions in airflow and gas-exchange

how can hypertension lead to blood dysfunction

certain conditions cause abnormal constriction of the blood vessels increasing pressure the heart has to work against to pump blood (SVR)

systemic vascular resistance (SVR)

the pressure in the peripheral blood vessels the blood has to overcome to pump blood into the system

how can loss of regulation lead to blood dysfunction

an absence of messengers to vaso- dilate or constrict can lead to dropping of circulatory system pressure and shock

stroke volume

amount of blood ejected from the heart in one contraction (~ 70 ml of blood per contraction)

preload

how much blood is returned to the heart or how much the heart is filled - greater the filling of the heart = the greater the stroke volume

contractility

force of contraction - more forceful contractions = greater stroke volume

afterload

how much pressure the heart has to pump against to force blood into the circulatory system - greater the pressure = greater the stroke volume

three components that affect stroke volume

preload, contractility, and afteload

cardiac output

amount of blood ejected from the heart in one minute (HR * stroke volume)

bradycardia and steep tachycardia both tend to _____ cardiac output

decrease (although a slight increase in heart rate tends to INCREASE heart rate, i.e. exercise)

children lack the contractile muscles to regulate the force of the squeeze, to compensate, children _____ _____ _____ to compensate for poor perfusion

increase heart rate

a V/Q (ventilation/perfusion) match is

the alveoli is supplied with enough air and that air is sufficiently being exchanged with blood in the pulmonary capillaries

the opposite of a V/Q math is a _____ _____, or hypoperfusion (or shock)

V/Q mismatch

when does hypoperfusion (shock) occur

when the regular delivery of oxygen and nutrients to cells, and removal of their waste products, are interrupted

four groups of shock categories are

hypovolemic, distributive, cardiogenic, and obstructive

hypovolemic shock

low blood volume - occurs when blood is lost from the cardiovascular system decreasing pressure heart has to pump blood adequately through the body (ex. severe bleeding, dehydration)

distributive shock

blood vessel tone (ability to control diameter) is lost - lowers pressure, blood cannot efficiently be pumped (ex. anaphylaxis, sepsis)

cardiogenic shock

heart fails in its ability to pump blood - cardiac output fails, hypoperfusion occurs (ex. myocardial infarction, trauma, damage to heart muscle (mechanical) )

obstructive shock

blood is physically prevented from flowing - large quantities of blood cannot reach essential organs and vital areas (ex. tension pneumothorax, pericardial tamonade, pulmonary embolism)

compensated shock

when the body adjusts for shock (hypoperfusion) - primarily through a sympathetic NS response

inadequate compensation for shock results in the body falling into _____

decompensated shock

irreversable shock

failure to compensate for shock, often leads to death

signs and symptoms of compensated shock

altered LOC, increased HR, increased respiratory rates, delayed capillary refill time (>2 seconds), diaphoresis (pale/clammy/cool/moist skin), sweating

_____ percent of the body weight stems from _____

60 ; water (divided into intercellular, intravascular, and interstitial)

disruptions in fluid balance can occur in what two ways

dehydration (loss of fluid), and poor fluid distribution (edema)

the greater the injury or trauma, the greater the shift in _____

fluid distribution - especially when pressure is high

ways in which the nervous system can become disrupted

trauma and medical dysfunction

medical dysfunction in the nervous system can be in what forms

infection (meningitis) or general medical problems (low blood sugar)

digestive disorders can drastically lead to impacts on both _____ and _____

fluid balance ; nutrient transfer

hypersensitivity

extreme exaggeration response by the immune system to a particular substance

infancy age is from

birth to 1 year

toddler age is from

12-36 months

preschool age is from

3-5 years

school age is from

6-12 years

adolescence age is from

13-18 years

early adulthood age is from

19-40 years

middle adulthood age is from

41-60

late adulthood age is from

61+ years

the glottic opening is the boundary between the _____ and the _____ airways at the level of the vocal cords

upper ; lower

the trachea bifurcates into the two mainstem bro

carina

What are the airway differences between children and adults regarding mouth/nose size?

Children's mouth/nose are smaller, which makes them more easily obstructed.

How does the size of the tongue affect children's airways?

The tongue in children takes up more space in the mouth, which can easily obstruct the airway

What unique breathing characteristic do newborns and infants have?

Newborns and infants breathe through their nose, not their mouth. Nasal obstruction can lead to airway impairment.

How does the structure of the trachea differ in children?

The trachea in children is softer, more flexible, and narrower, resulting in a higher risk of obstruction from swelling and foreign objects.

What is a characteristic of the chest wall in infants?

the chest wall in infants is softer, and they depend more on their diaphragm for breathing

what is a common cause of airway obstruction in unconscious patients

the tongue/epiglottis falling back over the trachea due to loss of muscle control

a semi-unconscious and unconscious patient are more susceptible to airway obstruction in what position and are required to be continually monitored

the supine position

stridor

a high pitched ‘whistling’ sound usually caused by a severely restricted upper airway (ex. foreign object or swelling of upper airway)

hoarseness

voice change/raspy voice and an indication of swelling - an ominous sign that the airway will eventually likely close over time

snoring

soft tissue overlaping the upper airway (i.e. the tongue and epiglottis) - indication of loss of muscle tone and that the airway needs assistance opening

snoring can be normal unless in the case of _____ and _____

injury/trauma ; illness

gurgling

indication that the airway is obstructed via fluid/secretions (i.e. blood/vomit/liquids) - immediate suctioning is necessary

sounds of a partially obstructed airway

stridor, hoarsness, snoring, and gurgling

in order, what questions must be asked when assessing a patients airway

is the patient breathing → is the airway open → will the airway stay open →

signs of inadequate breathing

no signs of breathing/air movement

evidence of foreign objects/fluids in airway

no air can be felt or heard through nose or mouth

patient is unable to speak/has difficulty speaking

patients voice is unusually hoarse/raspy

minimal/uneven chest rise and fall

abdominal breathing

diminished/absent breath sounds

strange noises noted (stridor, hoarseness, etc.)

is children, what particularly is a sign of an inadequate airway not usually seen in adults

muscle retractions (pulling in of muscles above clavicle/ribs) and nasal flaring at the nose

ventilation

breathing in and out (inhalation and exhalation)

inhalation is an _____ process, while exhalation is a _____ process

active ; passive

normal tidal volume

5-7 ml per kg of body weight

ventilation does not always mean the patient is actively doing _____ and exchanging gases in the alveoli

respirations

alveolar ventilation

the amount of air that reaches the alveoli

diffusion

movement of gas from high to low concentration - oxygen and carbon dioxide diffusion takes place in the alveoli

pulmonary respiration (external respiration)

exchange of oxygen and carbon dioxide between circulating blood in the pulmonary capillaries

cellular respiration (internal respiration)

exchange of oxygen and carbon dioxide between cells and circulating blood

a patient who is stabbed in the chest, is unable to create _____ _____ in the chest due to air rushing into the stab wound

negative pressure - which makes it unable to pull air through the airway passages

respiration refers to the

exchange of gas between the alveoli and the blood

ways to check for hypoxia

pulse ox, capillary refill time

respiratory distress (adequate breathing)

difficulty breathing or cannot breath comfortably (compensating)

characterized by: shortness of breath or rapid breathing

respiratory failure (inadequate breathing)

the respiratory system fails in removing carbon dioxide from blood and oxygenating blood

characterized by: increased hypoxia, build up of carbon dioxide, and respiratory muscles tire