Module 3 - Emergencies

Ventilation

Ventilation

includes inhalation and exhalation, one full breath

What has to happen for a person to inhale?

diaphragm goes down and ribs go out, the air diffuses from high to low concentration into the lungs until pressure is equal

What has to happen for a person to exhale?

diaphragm comes back up and ribs back in and air rushes out by diffusion

External respiration

in the alveoli, diffusion of oxygen in the lungs to bloodstream

Internal respiration

diffusion of oxygen, water and glucose from the capillaries into cells

Cellular respiration

process of making ATP from oxygen, water and glucose

Hypoxia

low oxygen in body

Stridor

whistling blockage in upper airway

Mottled

patchy skin red/blue skin color

Flushed

red skin color

Jaundice

yellow skin and possible eye color

Cyanotic

blue skin

Wheezing

gasping, labored breathing in lower airway

Apnea

not breathing

Crepitus

bones grinding against each other, OR popping and cracking under the skin and joints.

Dyspnea

difficulty breathing

What is the air pillow like structure that is wrapped in capillaries?

alveoli

Hypercapnia

a high level of CO2 in the bloodstream

What are the causes of hypoxia?

Smoke, trauma, disease such as emphysema, lung cancer, heart attack, COPD, drowning, high fever, pressure on the chest, congestive heart failure, asthma, chronic bronchitis

List the signs of inadequate breathing

pale, cool, clammy skin, lung sounds like stridor and wheezing, cyanotic, breathing rate very high, percent oxygen low, altered mental status, possibly unconscious

Pulse oximeter reading

It looks at the hemoglobin of the red blood cells and shows the percent of hemoglobin that is covered by another molecule. An advance oximeter will tell whether the molecules are O2 which people can use for cellular respiration or CO (carbon monoxide) which can not be used for cellular respiration.

What can give incorrect readings on a pulse oximeter?

nail polish, smoker, lotion, cold fingers.

Tachypnea

breathing at a fast rate

Nasal flaring

a sign in children that they are having trouble breathing and moving to hypoxia

Capillary refill

a sign in children they have hypoxia, press the nail bed, skin under turns white and then measures the time it takes to turn back to the normal skin color. It should be less than 2 seconds in children.

The _______ is easily obstructed in children

trachea

Head size

children have a head bigger in comparison to their body

Airway size

smaller in children

Breathing rate

faster in children

Heart rate

faster in children

How do you decide which way to open the airway (head/tilt/chin lift or jaw thrust)?

trauma to head or back then do jaw thrust otherwise head tilt/chin lift

How do you decide whether you choose a non-rebreather or a BVM?

BVM (not breathing, breathing less than 8 or more than 24, pulse ox less than 86%, could be unconscious, usually trauma situation), Nonrebreather (complain of trouble breathing, signs of hypoxia, pulse ox 86-95%, must look at the entire patient to decide)

Air that is coming out of an oxygen tank used for breathing treatment is ___ oxygen

100%

What is a CPAP machine and when is it used?

continuous positive airway pressure is for respiratory distress patients, like those with pulmonary edema from congestive heart failure, bronchitis, emphysema, asthma

What color is an oxygen canister?

Green

What is the procedure to giving oxygen to a patient with a stoma?

Use tracheostomy mask, mask over stoma, cover mouth

What circumstances could continued oxygen therapy cause a hazard to a patient?

Patients with COPD like emphysema could have decreased breathing rates, decreased cardiac output, gastric distention, and dangerous changes in blood pressure.

Why is it so important to get the right size C collar on a patient?

Too loose means that the neck not stabilized, spine can be injured. Too tight can cause breathing difficulty

A patient has been found supine in bed with her head resting on a pillow. She is not breathing. What is one of the first things you should do before hooking up oxygen?

Open airway, remove pillow

Explain the procedure to do suctioning.

Place patient on their side, turn on the machine, place the rigid catheter, yankauer tip into the mouth as far as you can see, place your finger over the hole, suction back and forth as you pull the catheter out. You should suction for no more than 10 seconds.

What is the whole purpose of the Primary Assessment?

Find and treat any life threats

You are on a call and size up the scene as you approach. When does sizing up the scene around you stop on a call?

Always pay attention to the scene around you for the whole call. The scene size up only stops when you leave the scene.

What is an intervention?

The procedures and/or medicine you would do to help the patient.

What is a contraindication?

Conditions where a medication should not be used.

What could be done with a towel to help a child breathe better?

Put it under shoulders

What are baseline vitals and when are they first taken?

Pulse, bp, pulse ox, breathing rate, depth and quality (taken during primary assessment)

What is the time limit for suctioning?

No more than 10 seconds.

You find an infant that appears to be nonresponsive. How should you check for responsiveness in an infant?

Tap the foot

What does trending mean?

Compare the baseline vital signs to the recent vital signs. Are they stable?, getting worse?, condition getting better?

What is the difference between a sign and a symptom?

Sign is something you can see and measure, symptoms are what the person tells you and is subjective.

What does AVPU stand for?

Alert verbal, painful, unresponsive

What three things are you looking for when checking a victim's eyes?

PERRL pupils equal, round, reactive to light.

A fall that is _____ times the height of the person is considered trauma.

3

A medical assessment patient is checked ______

5-10 minutes

A patient in trauma should be rechecked every _______ minutes.

5

Where does the reassessment start again at?

Go back to vitals in primary assessment, back up to abcs

Define what anaphylactic shock is

allergic reaction, blood pressure drops, bronchioles constrict, hard to breathe

What happens to you as your body initially goes into anaphylactic shock

Blood pressure drops, heart rate increases, breathing rate increases, bronchioles constrict

What is the normal range for blood sugar?

70-120

When checking a patient during a trauma check. What are the three things that are checked in the chest?

lung sounds (auscultate), tenderness (palpate), deformities (inspect)

Define what shock is

hypoperfusion, the lack of oxygen to all the cells of your body.

Normal Pulse Ox

95% and above

Nasal Cannula

pulse ox is 90-95%, 4-6 L/min

Nonrebreather

pulse ox is 86-90%, airway is patent, 12-20 breaths per minute, struggling with breathing, 10-15 L/min

BVM

low pulse ox below 86%, less than 8 or more than 24 breaths per minute, unconscious, 10-15 L/min

If the airway is non patent

use head tilt chin lift or jaw thrust

What direction does the diaphragm and your rib muscles move in inhalation?

out

What direction does the diaphragm and your rib muscles move in exhalation?

relax

Cardiac arrest

loss of heart function from electrical malfunction, an electrical problem

Heart Attack

Myocardial Infarction, blood flow to heart is blocked, tissue dies, a circulation problem

CPR and its purpose

actions taken to revive a person by getting blood with oxygen to the brain tissue with cells. These cells can possibly then still make ATP and will not die or kill the person.

Defibrillation and its purpose

delivery of an electrical shock with an AED to stop the fibrillation of heart muscles. The heart tissue (SA and AV nodes) will then start the electricity again (automaticity) and restore a normal heart rhythm

Name the four chambers of the heart

right atrium, right ventricle, left atrium, left ventricle

Name two arteries on the outside of the heart (coronary arteries) that keep the heart alive.

left & marginal artery

What does the heart have to have to keep the heart tissue alive?

Oxygen, glucose and water from the blood.

What are the two large veins going into the heart?

Pulmonary vein, inferior and superior vena cava

The right side of the heart has (oxygenated, deoxygenated) blood.

deoxygenated

Where does the pulmonary artery go to?

The lungs

True or false. Both atria fill with blood and then contract and then both ventricles fill with blood and contract.

True

What causes the lub, dub sound of the heart?

Bi and tricuspid valves closing for the lub and the pulmonary semilunar valve and aortic semilunar valves closing in the heart for the dub

Name three things that are in blood that are pumped out to the cells including heart tissue cells.

oxygen, water, glucose

The heart makes its own electricity. What is this ability called?

Automaticity

The electricity goes from the SA node and causes these to contract (atria) and then goes to the _______ node which causes these to contract.

AV, ventricles

Describe what shock is.

hypoperfusion, inadequate tissue perfusion at the cellular level, all types will have altered mental status

Hypovolemic shock

lack of fluid, blood loss, dehydration, pale, cool, clammy, common in geriatric patients, massive release of epinephrine causes this, can also be called hemorrhagic shock, tachycardic heart rate

Distributive shock

Anaphylactic shock

distributive shock, allergic reaction (histamines) causes all blood vessels dilate, low blood pressure, bronchial tubes constrict, hives caused by capillaries dilating, red, itchy, warm, this will not be cool or clammy.

Neurogenic shock

distributive shock, blood vessels all dilate as result of spinal cord or nerve damage, low blood flow from low blood pressure all over body, below injury will be warm, dry, above injury will be cool, clammy, body trying to move blood from extremities to core to try to compensate for low blood pressure, slow heart rate

Septic shock

distributive shock, skin is hot, most likely low blood pressure

Obstructive shock

examples of causes

Cardiogenic shock

myocardial infarction, heart failure, heart problems, low or no blood flow, tachycardic heart rate

Compensated shock

AO X 4, normal range blood pressure, high heart rate, high respiration rate

Decompensated shock

not alert, dropping blood pressure, increased heart rate, high respiration rate

Irreversible shock

unresponsive

Acute Coronary Syndrome

a blanket term used to represent any symptoms related to lack of oxygen (ischemia) in the heart muscle. Includes angina pectoris and Myocardial Infarction

Acute Coronary Syndrome is also known as

cardiac compromise

Name the five symptoms of heart problems

pain in the center of chest, nausea, vomiting, sweating, mild chest discomfort, no pain at all

Treatment

Nitroglycerin

relaxes blood vessels in coronary arteries and decreases the workload of heart; dilates coronary arteries; one dose every 5 minutes up to 3 doses. .4 mg each tablet; Indications; patient complains of chest pain, patient has a history of cardiac problems, patient's physician has prescribed nitroglycerin, systolic blood pressure is greater than 90; person has not taken an ED drug lately. Contraindications

Medical direction authorizes the administration of the nitroglycerin. TRUE