EMT Test 3

Signs and symptoms of inadequate ventilation:

-Altered mental status -Inadequite minute volume (fast, short breaths) -Excessive accessory muscle use and fatigue (Stomach distending in infants and children, and nasal flaring in young children) (Look at traction in accessory muscles, thinner patients, you can see ribs

Inaccurate Pulse Oximetry Readings/Problems With Pulse Ox

-hypovolemia -anemia -severe peripheral vasoconstriction (chronic hypoxia, smoking, or hypothermia) -time delay in detecting respiratory insufficiency -Nail Polish (Especially dark or metallic nail polish) -dirty fingers/ Cold Fingers -carbon monoxide poisoning -Fractures in arm or finger Basic pulse ox doesn't know the difference between gases, it is just looking at hemoglobin- doesn't know CO2 or O2

Nasal Cannula Flow Rate

1-6 L/min 24%-44% O2 delivered

One-Handed Carry

1. Face each other and lift using both hands (Four EMT's, two on each side) 2. Turn in the direction you want to walk, and switch to using one hand If you have to carry a stretcher with only two people, the EMT at the foot end will have to walk backwards

Direct Carry

1. Position stretcher parallel to bed, secure the stretcher to prevent movement 2. face towards the patient 3. Slide your arms under the patient's neck and shoulders. Partner should slide their hands under the patient's knees and lock them together or use them to grasp the posterior part of the patient's thighs 4. Lift patient up slowly and smoothly. Partner should move knees from left side of his body to the right 5. Slowly carry the patient from bed to stretcher 6. Gently lower patient to stretcher and secure with straps

Normal Respiratory Rates

12-20 breaths/min Adults 15-30 breaths/min children 25-50 breaths/min infants

Bag-Mask Device with Reservoir

15 L/min nearly 100% Adequate tidal volume is often difficult to achieve when one EMT is operating the bag-mask device. Employ CE Grip

Mouth to Mask Device Flow Rate

15 L/min, nearly 55% ventilation rates

During pulling, extend your arms no more than about:

15-20 inches in front of your torso

Orders that will initiate the actual lifting or moving or any significant changes should be given in:

2 Parts Preparatory command and command of execution

What is the approximate pressure per square inch of a full O2 tank?

2000 lbs/sq in (psi) An oxygen cylinder should be taken out of service and refilled when the pressure inside it is less than 500 psi.

Room air is essentially:

21%

A properly operating suction unit should generate:

300 mm/Hg of pressure

Brain tissue will begin to die within:

4-6 Minutes without oxygen Within seconds, organs may stop functioning normally Critical time of lack of oxygen: 0-1 min: cardiac irritability 0-4 min: brain damage not likely 4-6 min: brain damage possible 6-10 min: brain damage very likely Over 10 min: irreversible brain damage

With a good mask-to-face seal and an oxygen flow rate of 15 L/min, the nonrebreathing mask is capable of delivering up to ______% inspired oxygen.

90%

The EMT should assess a patient's tidal volume by: 1. observing for adequate chest rise. 2. assessing the facial area for cyanosis. 3. counting the patient's respiratory rate. 4. measuring the patient's oxygen saturation.

A Tidal volume—the volume of air that is moved into or out of the lungs in a single breath—is assessed by observing for adequate chest rise. If shallow chest rise is noted, the patient's tidal volume is likely reduced.

On which of the following patients would it be MOST appropriate to use the flow-restricted, oxygen-powered ventilation device? A) an 8-year-old female with respiratory failure B) a 21-year-old male with traumatic cardiac arrest C) a 38-year-old apneic female with blunt chest trauma D) a 59-year-old male with chronic obstructive pulmonary disease (COPD)

A 21-year-old male with traumatic cardiac arrest

Which of the following patients would MOST likely require insertion of an oropharyngeal airway?

A 40-year-old unconscious patient with slow, shallow respirations

An injured hang glider is trapped at the top of a large mountain and must be evacuated to the ground. The terrain is very rough and uneven. Which of the following devices would be the safest and most appropriate to use? Stair chair Stokes basket Scoop stretcher Long backboard

A basket stretcher, also called a Stokes basket, should be used to carry patients over rough or uneven terrain that is inaccessible by ambulance. Its closed-ended sides protect the patient from falling out of the device.

Cyanosis

A blue-gray skin color that is caused by a reduced level of oxygen in the blood

Bilateral

A body part or condition that appears on both sides of the midline

Bariatrics

A branch of medicine concerned with the management (Prevention or control) of obesity and allied diseases Usually for patients above 350 1/3 of adults in U.S are considered obese- higher among 40-59 year old (17% of children) Bariatric Stretcher: Wider patient surface area Max weight of 850-900, as opposed to 650 lbs Pneumatic and electronic stretchers are becoming an option, but the technology adds about 100 extra pounds of weight

SAMPLE History

A brief history of a patient's condition to determine signs and symptoms, allergies, medications, pertinent past history, last oral intake, and events leading to the injury or illness

Diamond Carry

A carrying technique in which one provider is located at the head end of the stretcher or backboard, one at the foot end, and one at each side of the patient; Each of the two providers at the sides of the patient uses one hand to support the stretcher or backboard so that all are able to face forward as they walk.

Subcutaneous Emphysema

A characteristic crackling sensation felt on palpation of the skin, caused by the presence of air in soft tissues Air bubbles under skin

Nonrebreather Mask

A combination mask and reservoir bag system that is the preferred way to give oxygen in the prehospital setting Delivers up to 90% inspired oxygen and prevents inhaling the exhaled gases (carbon dioxide) Often used for unconscious patients or severe respiratory complaints

Head Tilt-Chin Lift Maneuver

A combination of two movements to open the airway by tilting the forehead back and lifting the chin Not used for trauma patients Used when you are not worried about c-spine

Larynx

A complex structure formed by many independent cartilaginous structures that all work together Where the upper airway ends and the lower airway begins AKA Voice Box

Carbon Dioxide

A component of air Typically makes up .3% of air at sea level Also a waste product exhaled during expiration by the respiratory system

Gastric Distention

A condition in which air fills the stomach, often as a result of high volume and pressure during artificial ventilation (Ventilate too rapidly/forcefully) More common with children May also occur when the airway is obstructed when ventilating

Hypoxic Drive

A condition in which chronically low levels of oxygen in the blood stimulate the respiratory drive The primary stimulus to breathe for patients with certain chronic respiratory diseases Seen in patients with chronic lung diseases Influenced by low blood oxygen levels/ oxygen dissolved in plasma

Hypothermia

A condition is which the internal body temperature falls below 95 Deg Fahrenheit after exposure to a cold environment

Oxygen Toxicity

A condition of excessive oxygen consumption resulting in cellular and tissue damage

Crackles

A crackling, wet, rattling breath sound that signals fluid in the air spaces of the lungs Usually on both inspiration and expiration Alveoli popping open (they collapsed because of pressure)

Hypoxia

A dangerous condition in which the body tissues and cells do not have enough oxygen

Bag-Valve Mask (BVM)

A device with a one-way valve and a face mask attached to a ventilation bag When attached to a reservoir and connected to oxygen, it delivers more than 90% supplemental oxygen. Reservoir bag should stay inflated If using bag-valve to ventilate, use 15 L/min OXYGEN FLOW FIRST 10-15 L/min

Manually Triggered Ventilation Device

A fixed flow rate ventilation device that delivers a breath every time its button is pushed Also referred to a flow-restricted, oxygen-powered ventilation device

Stridor

A harsh, high-pitched, breath sound, generally heard during inspiration, that is caused by partial blockage or narrowing of the upper airway, can be caused by swellling May be audible without a stethoscope Brassy, crowing sound

Suction Catheter

A hollow, cylindrical device used to remove fluid from the patients airway

Tension Pneumothorax

A life-threatening collection of air within the pleural space The volume and pressure have both collapsed the involved lung and caused a shift of the mediastinal structures to the opposite side

Power Lift

A lifting technique in which the EMT's back is held upright, with legs bent, and the patient is lifted when the EMT straightens the legs to raise the upper body and arms. Most useful and safest method Keep weight close to body, don't outstretch arms

Direct Ground Lift

A lifting technique that is used for patients who are found lying supine on the ground with no suspected spinal injury. Use when you might have to carry the patients some distance Log roll patient onto back if needed Ideally done with three providers, doable with 2 Mummy Lift

Extremity Lift

A lifting technique that is used for patients who are supine or in a sitting position with no suspected extremity or spinal injuries. Helpful in narrow space Cross patients hands over chest and grab patients wrists or forearms

Stair Chair

A lightweight folding device that is used to carry a conscious, seated patient up or down stairs One partner at head end, and one at feet Do not use when the patient is unresponsive, must be moved in the supine position, or must be immobilized Make sure to strap in arms and feet

Surfactant

A liquid protein substance that coats the alveoli in the lungs, decreases alveolar surface tension, and keeps the alveoli expanded A low level in a premature infant contributes to respiratory distress syndrome

Backboard

A long, flat board made of rigid, rectangular material that is used to provide support to a patient who is suspected of having a hip, pelvic, spinal, or lower extremity injury Also called a spine board, trauma board, and longboard Often used for patients found lying down or in awkward positions, and for stairs not conquerable by a stair chair Take patient down-stairs feet first

AVPU Scale

A method of assessing the level of consciousness by determining whether the patient is awake and alert, responsive to verbal stimuli or pain, or unresponsive Used principally early in the assessment process

Continuous Positive Airway Pressure (CPAP)

A method of ventilation used primarily in the treatment of critically ill patients with respiratory distress Often used for congestive heart failure and pulmonary edema Can prevent the need for endotracheal intubation Instant Relief Patient must be conscious and able to maintain their own airway PEEP Can potentially cause pneumothorax

DCAP-BTLS

A mnemonic for assessment in which each area of the body is evaluated for deformities, contusions, abrasions, punctures/penetrations, burns, tenderness, lacerations, and swelling.

OPQRST

A mnemonic used in evaluating a patient's pain Onset, provocation/palliation, quality, region/radiation, severity, and timing

Emergency Move

A move in which the patient is dragged or pulled from a dangerous scene before assessment and care are provided. Only use if you cannot properly assess the patient or provide critical emergency care because of the patient's location or position Fire, explosives, hazardous materials, inability to gain access to others in a vehicle who need life-saving care, you are alone at a dangerous scene (regardless of patient injuries).... Drag to pull patient along the long axis Use patients clothing, a blanket, wrist above head, or under armpits to pull patient backwards One of your primary concerns is aggravating an existing spinal injury If removing from car, make sure to take feet off pedals Dragging methods: Emergency clothes drag, blanket drag, arm drag, arm-to-arm drrag

Capnography

A noninvasive method to quickly and efficiently provide information on a patient's ventilatory status, circulation, and metabolism. Effectively measures the concentration of carbon dioxide in expired air over time.

Gag Reflex

A normal reflex mechanism that causes retching Activated by touching the soft palate or the back of the throat

Priapism

A painful, tender, persistent erection of the penis Can result from spinal cord injury, erectile dysfunction drugs, or sickle cell disease

Pneumothorax

A partial or complete accumulation of air in the pleural space Difference in ventilations between sides of chest

Diffusion

A process in which molecules move from an area of higher concentration to an area of lower concentration Oxygen moves across alveolar membrane onto hemoglobin

Barrier Device

A protective item, such as a pocket mask with a valve, that limits exposure to a patient's body fluids

Tachycardia

A rapid heart rate More than 100 beats/min

Basket Stretcher

A rigid stretcher commonly used in technical and water rescues that surrounds and supports the patient yet allows water to drain through holes in the bottom Also called a Stokes litter If patient has spinal injury, put them on backboard, and backboard into basket Made of plastic with alluminum frame, sometimes wire woven mesh (uncomfortable)

American Standard Safety System

A safety system for large oxygen cylinders, designed to prevent the accidental attachment of a regulator to a cylinder containing the wrong type of gas

2-3 Word Dyspnea

A severe breathing problem in which a patient can speak only two to three words at a time without pausing to take a breath

Recovery Position

A side-laying position used to maintain a clear airway in unconscious patient with no injuries who are breathing adequately Place an unresponsive patient with no suspected hip, spinal, pelvic or neck injuries in recovery position

Bradycardia

A slow heart rate, less than 60 beats/min

Wheeled Ambulance Stretcher

A specially designed stretcher that can be rolled along the ground. (Weighs between 40-145 lbs) Not generally used for stairs or long distances A collapsible undercarriage allows it to be loaded into the ambulance Can be raised from 12 in (Ambulance Height) to 32-36 in (Rolling height) Also called an ambulance stretcher/gurney Most commonly used device to move and transport patients/Ideal for transport (Only when you must transfer two patients in the same ambulance should you use a folding stretcher or backboard placed on the long squad bench) When you reach the ambulance, lower the stretcher as low as possible before loading Most patients are placed directly on the WAS, unless there is a possible spinal injury or multisystem trauma, or patients who need to be transported down stairs on backboard

Secondary Assessment

A step within the patient assessment process in which a systematic physical examination of the patient is performed The examination may be a systematic exam or an assessment that focuses on a certain area or region of the body, often determined through the chief complaint

Reassessment

A step within the patient assessment process performed at regular intervals during the assessment process to identify and treat changes in a patient's condition. A patient in unstable condition should be reassessed every five minutes, whereas a patient in stable condition should be reassessed every 15 minutes

Primary Assessment

A step within the patient assessment process that identifies and initiates treatment of of immediate and potential life threats

Scene size-up

A step within the patient assessment process that involves a quick assessment of the scene and the surroundings to provide information about scene safety and the mechanism of injury or nature of illness before you enter and begin patient care.

History Taking

A step within the patient assessment process that provides detail about the patient's chief complaint and an account of the patient's signs and symptoms

Flexible Stretcher

A stretcher that is a rigid carrying device when secured around a patient but can be folded or rolled when not in use Useful to remove patient from confined spaces or if patient must be belayed Most uncomfortable, but it provides excellent support and immobilization Can be slid down steps

Scoop Stretcher

A stretcher that is designed to be split into two or four sections that can be fitted around a patient who is lying on the ground or other relatively flat surface. Also called an orthopedic stretcher Can be used for patient found on the ground To use, all sides of the patient must be accessible *Don't pinch anything May be used for patients hit by a motor vehicle Not adequate for spinal injury when used alone

Portable Stretcher.

A stretcher with a strong rectangular, tubular metal frame and rigid fabric stretched across it. Does not have second multipositioning frame or adjustable undercarriage Some have 2 wheels or fold in half Used for hard-to-reach areas or when second patient must be transported on squad bench

Pin-Indexing System

A system established for portable cylinders to ensure that a regulator is not connected to a cylinder containing the wrong type of gas

Incident Command System

A system implemented to manage disasters and mass and multiple-casualty incidents in which section chiefs, including finance, logistics, operations, and planning, report to the incident commander. A.K.A Incident Management System

Power Grip

A technique in which the stretcher or backboard is gripped by inserting each hand under the handle with the palm facing up and the thumb extended, fully supporting the underside of the handle on the curved palm with the fingers and thumb. Hands should be about ten inches apart

Rapid Extrication Technique

A technique to move a patient from a sitting position inside a vehicle to supine on a backboard in less than one minute (As opposed to 6-8 minutes) when conditions do not allow for standard immobilization. Use when: Vehicle or scene is unsafe, explosives or other hazardous materials, fire or danger of fire, patient can't be properly assessed before removal, patient needs immediate intervention that requires supine position or rapid transport to hospital, patient blocks access to another seriously injured patient Requires at least three providers (First provides in-line manual support of head and cervical spine, second gives commands, applies cervical collar, supports torso, third move the patient's legs Body hug is often used Don't forget cervical collar Slide patient onto backboard 8-12 inches at a time Pg 286

Poor Air Exchange

A term used to describe the degree of distress in a patient with a mild airway obstruction With poor air exchange, the patient often has a weak, ineffective cough, increased difficulty breathing, or possible cyanosis and may produce a high-pitched noise during inhalation (stridor)

Good Air Exchange

A term used to distinguish the degree of distress in a patient with a mild airway obstruction With good air exchange, the patient is still conscious and able to cough forcefully, although wheezing may be heard

Capillary Refill

A test that evaluates distal circulatory system function by squeezing (blanching) blood from an area such as a nail bed and watching the speed of its return after releasing the pressure.

Focused Assessment

A type of physical assessment typically performed on patients who have sustained non-significant mechanisms of injury or on responsive medical patients. This type of exam is based on the chief complaint and focuses on one body system or part.

Automatic Transport Ventilator (ATV)

A ventilation device attached to a control box that allows the variables of ventilation to be set. It frees the EMT to perform other tasks while the patient is being ventilated

The EMT should assess a patient's tidal volume by: A. observing for adequate chest rise. B. assessing the facial area for cyanosis. C. counting the patient's respiratory rate. D. measuring the patient's oxygen saturation.

A. Tidal volume—the volume of air that is moved into or out of the lungs in a single breath—is assessed by observing for adequate chest rise. If shallow chest rise is noted, the patient's tidal volume is likely reduced

During insertion of an oropharyngeal airway into an unconscious patient, she begins to vomit. The first thing you should do is: A.turn the patient on her side. B.remove the airway at once. C.suction the patient's mouth. D.use a smaller-sized oral airway.

A. Whenever an unconscious patient begins to vomit—whether you are inserting an oropharyngeal airway or not—you should immediately turn the patient onto his or her side; this will allow drainage of vomit from the mouth and prevent aspiration. After the patient is on his or her side, remove the oral airway and suction the mouth.

Initial care is always focused on:

ABC's Airway, Breathing, and Circulation

Isolette

AKA Incubator Used to transport neonatal patient

Apnea

Absence of spontaneous breathing

Suctioning Time Limits

Adult 15 seconds Child 10 seconds Infant 5 seconds

Oropharyngeal (Oral) Airway

Airway adjunct inserted into the mouth of an unresponsive patient to keep the tongue from blocking the upper airway and to facilitate suctioning the airway, if necessary Don't use on patient with a gag reflex Don't allow movement of the head

Nasopharyngeal (nasal) Airway

Airway adjunct inserted into the nostril of an unresponsive patient or a patient with an altered level of consciousness who is unable to maintain airway patency independently Don't use if there is a suspected head injury (it can go into brain) Use if patients are semiconscious or unconscious but have a gag reflex

Pulse Oximetry

An assessment tool that measures oxygen saturation of hemoglobin in the capillary beds.

Breath Sounds

An indication of air movement in the lungs, usually assessed with a stethoscope.

Stoma

An opening through the skin and into an organ or other structure A stoma in the neck connects the trachea directly to the skin They make stoma masks, but you can use a pediatric mask

Nasal Cannula

An oxygen-delivery device in which oxygen flows through two small, tubelike prongs that fit into the patient's nostrils Delivers 24%-44% supplemental oxygen, depending on the flow rate Nasal Cannula goes up 4% with each liter added NASAL CANNULA: MAX OF 6 L/MIN (2-6) (TYPICALLY IF THEY NEED 6 GO TO NONBREATHER)

Tripod Position

An upright position in which the patient leans forward onto two arms stretched forward and thrusts the head and chin forward Significant conscious effort is required for breathing Indicates difficulty breathing

Sniffing Position

An upright position in which the patient's head and chin are thrust slightly forward to keep the airway open

Altered Mental Status

Any deviation from alert and oriented to person, place, time, and event, or any deviation from a patient's normal baseline mental status.

Distracting Injury

Any injury that prevents the patient from noticing other injuries he or she may have, even severe injuries. Painful femur or tibia fracture that prevents patient from noticing a back injury

Korotkoff Sounds

Arterial vibrations heard on stethoscope when checking bp Disappearance of korotkoff sounds indicates the diastolic pressure reading

You and your partner are treating a 66-year-old man who experienced a sudden onset of respiratory distress. He is conscious but is unable to follow simple verbal commands. Further assessment reveals that his breathing is severely labored and his oxygen saturation is 80%. You should:

Assist his ventilations with a bag-mask device.

Tallest/Strongest EMT's should be:

At the head of the stretcher The stretcher is designed so that the head is always higher than the feet, and that side of the body is heavier and more important

In which of the following patients would the head tilt-chin lift maneuver be the MOST appropriate method of opening the airway? A) a 24-year-old male who is found unconscious at the base of a tree B) a 37-year-old female who is found unconscious in her bed C) a 45-year-old male who is semiconscious after falling 20 feet D) a 50-year-old male who is unconscious following head trauma

B

You and your partner are ventilating an apneic adult when you notice that his stomach is becoming distended. You should: A. suction his airway for up to 15 seconds. B. reposition his head. C. increase the rate and volume of your ventilations. D. decrease your ventilation rate but use more volume.

B

Assessment of an unconscious patient's breathing begins by: A. inserting an oral airway. B. manually positioning the head. C. assessing respiratory rate and depth. D. clearing the mouth with suction as needed.

B You cannot assess or treat an unconscious patient's breathing until the airway is patent—that is, open and free of obstructions. Manually open the patient's airway (eg, head tilt-chin lift, jaw-thrust), use suction as needed to clear the airway of blood or other liquids, insert an airway adjunct to assist in maintaining airway patency, and then assess the patient's respiratory effort.

You and your partner are caring for a critically injured patient. Your partner is controlling severe bleeding from the patient's lower extremities as you attempt ventilations with a bag-mask device. After repositioning the mask several times, you are unable to effectively ventilate the patient. You should:

Begin ventilations using the mouth-to-mask technique.

Hypertension

Blood pressure that is higher than the normal range

Hypotension

Blood pressure that is normal than the lower range.

Breathing is controlled by an area in the: lungs. brain stem. spinal cord. diaphragm

Brain Stem The pons and the medulla are the respiratory centers in the brain stem that control breathing. Medulla works with chemoreceptors

Mental status directly correlates to:

Brain function

Oxygen reaches body tissues and cells through two separate but related processes:

Breathing and Circulation

Spontaneous Respirations

Breathing that occurs without assistance They could still be experiencing difficulty breathing

Labored Breathing

Breathing that requires greater than normal effort May be slower or faster than normal and characterized by grunting, stridor, and use of accessory muscles

What is a unique challenge when securing some elderly patients on a spine board?

Brittle bones, rigidity, spinal survatures (kyphosis and spondylosis), skin breakdown Get patient to lie on side, or use blankets Kyphosis=hump-back

Intrapulmonary Shunting

By-passing of oxygen poor blood past nonfunctional alveoli to the left side of the heart

Medical Restraints

Contact police and consult local protocols before restraining patients Minimum of five personal to assist (one for each limb and head) Bandage extremities so restraints don't hurt Upper extremities first Don't remove until you are at hospital and are requested to remove them by the hospital staff

How should you determine the pulse in an unresponsive 8-year-old patient? Palpate the radial pulse at the wrist. Palpate the brachial pulse inside the upper arm. Palpate the radial pulse with your thumb. Palpate the carotid pulse in the neck.

D In unresponsive patients older than 1 year, you should palpate the carotid pulse in the neck. If you cannot palpate a pulse in an unresponsive patient, begin CPR.

A patient is found unconscious after falling from a third-floor window. His respirations are slow and irregular. You should: 1. place him in the recovery position. 2. apply oxygen via a nonrebreathing mask. 3. suction his airway for up to 15 seconds. 4. assist his breathing with a bag-mask device.

D The patient is not breathing adequately. Slow, irregular respirations will not result in adequate oxygenation. You should assist the patient's breathing with a bag-valve mask attached to 100% oxygen. Suctioning is indicated if the patient has blood or other liquids in the airway; there is no evidence of this in the scenario.

The function of the lower airway is to:

Deliver oxygen to the alveoli Glottis to the pulmonary capillary membrane Trachea- Lungs (alveoli surrounded by capillaries (gas exchange)) Anatomy of lower airway: The heart and great vessels (Vena Cava and Aorta) are found in the thoracic cavity

Transfer Moves

Direct Carry: Bed to stretcher, similar to extremity lift Draw Sheet Method: Bed to Stretcher (log roll patient into blanket) Scoop Stretcher

Signs of Respiratory Distress and Failure

Distress: Agitation, anxiety, restlessness Stridor, wheezing Accessory muscle use; intercostal retrations, neck muscle use (sternomastoid) Tachypnea Mild Tachnycardia Nasal flaring, seesaw breathing, head bobbing Failure: Lethargy, difficult to rouse Tachypnea with periods of bradypnea or agonal respirations Inadequate chest rise/ poor excurion Inadequate respiratory rate or effort Bradycardia Diminished muscle tone

Scene-Size Up

Ensure scene safety Determine mechanisms of injury/Nature of illness Take Standard Precautions Determine number of patients Consider additional specialized resources

Structures of the lower airway include all of the following, EXCEPT the: A) alveoli. B) trachea. C) epiglottis. D) bronchioles.

Epiglottis

The _______ blocks the larynx during swallowing (by folding over the glottis)

Epiglottis Helps separate digestive and respiratory systems

Which of the following structures is contained within the mediastinum? A) lungs B) larynx C) bronchioles D) esophagus

Esophagus

Vacuum Mattresses

Especially for geriatric and pediatric patients Patient placed on mattress, air removed, it molds around the patient Provides thermal insulation Max of 350 lbs

Internal vs External Respirations

External respiration occurs in the lungs where oxygen diffuses into the blood and carbon dioxide diffuses into the alveolar air. (Pulmonary Respiration) (Brings fresh air into the respiratory system, exchanges oxygen and carbon dioxide between alveoli and blood in pulmonary capillaries). Watch out for carbon monoxide Internal Respiration: Exchange of oxygen and carbon dioxide between systemic circulatory system and cells.

Recognizing Abnormal Breathing

Fewer than 12 breaths/ more than 20 breaths per minute Irregular rhythm Diminished, absent (Not breathing or not ventilating (Real bad)), or noisy auscultated breath sounds Reduced flow of expired air at nose and mouth Unequal or inadequate chest expansion Increased effort of breathing Shallow Breath Skin that is pale, cyanotic, cool, or moist Skin pulling in around ribs or above clavicles during inspiration

Oropharynx

Forms the posterior portion of the oral cavity, which is bordered superiorly by the hard and soft palates, laterally by the cheeks, and inferiorly by the tongue

Most patients transported by EMS are:

Geriatric patients Pay special attention to skeletal changes (brittle bones, rigidity, spinal curvatures) and fear Cover older patients with blanket to preserve dignity, and only cut clothes when necessary because they may be poor

Important Note

If you are already in a residence and detect a hazard such as gas/CO/ect, you should take the patient with you as you quickly exit the area

Aspiration

In the context of airway, the introduction of vomitus or other foreign material into the lungs

Hypercarbia

Increased carbon dioxide level in the bloodstream

Guarding

Involuntary muscle contractions of the abdominal wall to minimize the pain of abdominal movement A sign of peritonitis

Ataxic Respiration

Irregular, ineffective respirations that may or may not have an identifiable pattern

Situational Awareness

Knowledge and understanding of your surroundings and situation and the risk they potentially pose to your safety or the safety of the EMS team.

Tonsil Tips

Large, semirigid suction tips recommended for suctioning the pharynx AKA Yankauer Tips

Assisted ventilations that are delivered too rapidly or with too much force can:

Lower BP Should be avoided If you notice lowering BP, assess your technique and make sure it is not too fast or aggressive

The reason that the patient called for an ambulance is always determined by in the:

MOI or in the Initial Assessment

The single most important step in caring for patients is to:

Make sure that life threats are addressed. -The primary component of caring for patients is ensuring that they can breathe adequately When the ability to breathe is disrupted, oxygen delivery to tissues and cells is compromised

Aerobic Metabolism

Metabolism that can proceed only in the presence of oxygen

Safety Tips for Lifting

Minimize the number of total body lifts you have to perform Coordinate every lift in advance Ask for help Do not carry weight you can put on wheels Don't push or pull from an overhead position

Chemoreceptors

Monitor the level of O2, CO2, and the pH of the cerebrospinal fluid and then provide feedback to the respiratory centers to modify the rate and depth of breathing based on the body's needs at any given time CENTRAL CHEMORECEPTORS ALTER RATE AND DEPTH OF RESPIRATION WHEN THEY DETECT A DECREASE IN pH AND AN INCREASE IN CO2 Located in the medulla

Retractions

Movements in which the skin pulls in around the ribs during inspiration

Which of the following organs or tissues can survive the longest without oxygen? A) muscle B) heart C) liver D) kidneys

Muscle (24-72 hours)

Suctioning

NEVER SUCTION THE MOUTH OR NOSE FOR MORE THAN 15 SECONDS AT ONE TIME FOR ADULT, 10 FOR CHILDREN, AND 5 FOR INFANT -Suctioning can result in hypoxia - After suctioning, ventilate for two minutes if pulmonary adema FRANK PULMONARY ADEMA: Frothy, runs out of nose and mouth Normally suction until airway is clear, but when a patient has uncontrolled bleeding from the airway we need to alternate suctioning with two minutes of respirations

Non Rebreathing Mask Flow

NON REBREATHER MASK FLOW SETTING: 10-15 L Up to 90% O2

Vasoconstriction

Narrowing of a blood vessel

Upper Airway (NN POMEL)

Nasopharynx Nasal Air Passage Pharynx (Naso, Oro, Laryngo/hypo) Oropharynx Mouth Epiglottis Larynx Warms, filters, and humidifies air The upper airway tract or the passage above the larynx, which includes the nose, mouth and throat

Pertinent Negatives

Negative findings that warrant no care or intervention

Phrenic Nerve

Nerve that innervates the diaphragm Necessary for adequate breathing to occur

A patient who is suspected of being hypoxic and is breathing adequately should be given supplemental oxygen with a:

Non-Breathing Mask

Sign

Objective findings that can be seen, heard, felt, smelled, or measured

Snoring Respirations indicate:

Obstructed airway Requires immediate opening and positioning of the airway properly

Agonal Gasps

Occasional, grasping breaths that occur after the heart has stopped (No heartbeat)- patient has gone into cardiac arrest, but brain is still sending impulses

Severe Airway Obstruction

Occurs when a foreign body completely obstructs the patient's airway The patient cannot breather, talk, or cough

Mid-Airway Obstruction

Occurs when a foreign body partially obstructs the patient's airway. The patient is able to move adequate amounts of air, but also experiences some degree of respiratory distress

Cheyne-Stokes

Often seen in patients with stroke or head injury

Patient Arm Restraints

One arm should be secured above head and one should be secured at side to prevent leverage.

Patent

Open, clear of obstruction

Urgent Moves

Patient with altered LOC, inadequate ventilation, shock (Hyperfusion), extreme weather Use rapid extraction technique for vehicles

Fowler/Semi-Fowler position is used for:

Patient's in respiratory distress

Internal Factors Affecting Respiration

Pneumonia PUlmonary Edema COPD/Emphysema

Carina

Point at which the trachea bifurcates (divides) into the left and right mainstem bronchi

Findings such as inadequate breathing or an altered level of consciousness should be identified in the: 1.primary assessment. 2.focused assessment. 3.secondary assessment. 4.reassessment.

Primary Assessment

Wheezing

Production of high-pitched, whistling breath sound that is most prominent on expiration, and which suggests an obstruction or narrowing of the lower airways. Occurs in asthma and bronchiolitis

Important Lifting Notes

Proportional Weight: The share of the weight that you will bear Don't attempt to lift a patient who weighs more than 250 lbs with fewer than four providers When lifting, do not twist or bend at the waist. Instead, flex at the hips and bend at the knees Between 68-78% of a patients weight is in the torso when on a stretcher, so more weight is in the head half Carry patient so that if they are cautious, they can see where they are going Push stretcher with elbows bent and hands 12-15 inches in front of the torso You need not retract the undercarriage for a single step Moving a patient is a dynamic process

Personal Protective Equipment (PPE)

Protective equipment that blocks exposure to a pathogen or a hazardous material

Standard Precautions

Protective measures that have traditionally been developed by the CDC (Centers for Disease Control and Prevention) for use in dealing with objects, blood, body fluids, and other potential exposure risks of communicable disease

A 19-year-old female is found unconscious by her roommate. Your primary assessment reveals that her breathing is inadequate. As you insert an oropharyngeal airway, she begins to gag violently. You should:

Remove the airway and be prepared to suction her oropharynx.

Shallow Respirations

Respirations characterized by little movement of the chest wall (Reduced tidal volume) or poor chest excursion

Dyspnea

Shortness of breath

Rapid Exam

Should take no longer than 60-90 seconds Identify life threats (DCAP-BTLS) Run across body quickly, get on a cervical collar if needed, get patient on backboard Not systematic or focused physical exam

Sign VS Symptom

Sign: Objective findings that can be seen, heard, felt, smelled, or measured Symptom: Subjective findings that the patient feels but that can be identified only by the patient

The diaphragm functions as an involuntary muscle when a person:

Sleeps

Crepitus

Sound or feeling of grating or grinding sensation caused by fractures bone ends or joints rubbing together Also air bubbles under the skin that produce a crackling sound or crinkly feeling

Mediastinum

Space within the chest between the lungs that contains the heart, major blood vessels, vagus nerve, trachea, major bronchi, and esophagus.

Kryphosis and Spondylosis

Spinal Curvatures Kyphosis=outward curve/humpback Spondylosis=pain and wear&tear of spine, spine curved inward

While eating dinner, your partner suddenly grabs his throat and has a panicked look on his face. He has a weak cough, faint inspiratory stridor, and cyanosis around the lips. You should:

Stand behind him and administer abdominal thrusts. When choking victim goes unconscious, start CPR (beginning with chest compressions) What is the modification to CPR for choking unconscious (look in airway, is there anything? If yes, pull it out, if no, do compressions)

Bronchioles

Subdivision of the smaller bronchi in the lungs Made of smooth muscle and dilate or constrict in response to various stimuli

Sympton

Subjective findings that the patient feels but that can be identified only by the patient

_________ position is best for opening airway

Supine Position

Tracheostomy

Surgical opening into the trachea

Jaw-Thrust Maneuver

Technique to open the airway by placing the fingers behind the angle of the jaw and bringing the jaw forward. Used for patients who may have a cervical spinal injury

Compliance

The ability of the alveoli to expand when air is drawn in during inhalation

Passive Ventilation

The act of air moving in and out of the lungs during chest compressions Expansion and contraction create a "pump" for air movement Benefits patients who are receiving chest compressions Can be enhanced using oropharyngeal airway and supplemental oxygen It's a good thing AKA passive oxygenation and apneic oxygenation Basically, process of EMT's compressing chest and forcing air out of thorax, resulting in negative pressure vacuum

Inhalation

The active, muscular part of breathing that draws air into the airways and lungs Active process (can be involuntary if we are unconscious)

Respiration

The actual exchange of oxygen and carbon dioxide in the alveoli as well as the tissues of the body The process of exchanging oxygen and carbon dioxide

Residual Volume

The air that remains in the lungs after maximal respiration

End-Tidal CO2

The amount of Carbon Dioxide present at the end of an exhaled breath

Tidal Volume

The amount of air (in milliliters) that is moved in or out of the lungs during one breath

Vital Capacity

The amount of air that can be forcibly expelled from the lungs after breathing in as deeply as possible

Metabolism (Cellular Respiration)

The biochemical processes that result in production of energy from nutrients within the cell

Metabolism

The biochemical processes that result in production of energy from nutrients within the cells

Conjunctiva

The delicate membrane that lines the eyelids and covers the exposed surface of the eye

Internal Respiration

The exchange of gases between the blood cells and tissues Between systemic circulatory system and cells

External Respiration

The exchange of gases between the lungs and the blood cells in the pulmonary capillaries AKA Pulmonary Respiration

Perfusion

The flow of blood through body tissues and vessels

Mechanism of Injury (MOI)

The forces, or energy transmission, applied to the body that cause injury

Nature of Illness (NOI)

The general type of illness a patient is experiencing

Systolic Pressure

The increased pressure in an artery with each contraction of the ventricles (systole)

Vital Signs

The key signs that are used to evaluate the patient's overall condition, including respirations, pulse, blood pressure, level of consciousness, and skin characteristics.

Orientation

The mental status of a patient as measured by memory of person (name), place (current location), time (current year, month, and approximate date), and event (what happened)

Anaerobic Metabolism

The metabolism that takes place in the absence of oxygen The principle product is lactic acid Cells function at low energy

Paradoxical Motion

The motion of the portion of the chest wall that is detached in a flail chest The motion (In during inhalation and out during exhalation) is exactly the opposite of normal chest wall motion during breathing

Nasopharynx

The nasal cavity, formed by the union of facial bones and protects the respiratory tract from contaminants

General Impression

The overall initial impression that determines the priority for patient care. Based on the patient's surroundings, and the chief complaint

Exhalation

The passive part of the breathing process in which the diaphragm and the intercostal muscles relax, forcing air out of the lungs Diaphragm contracts downwards Caused by increased intrathoracic pressure. Does not normally require effort (might require effort when there is an obstruction, like in asthma or emphysema (Lip pursing)) Passive process Smaller thorax compresses air into the lungs

Ventilation

The physical act of moving air into and out of the lungs. Ventilation is required for adequate respiration. If ventilation is adequate, other problems may hinder respiration. Examples of interruptions of ventilation include trauma such as flail chest, foreign body airway obstruction, or an injury to the spinal cord that disrupts the phrenic nerve, which innervates the diaphragm. Exchange of air between the lungs and the environment; Spontaneously by the patient or with assistance from another person, such as an EMT Intrinsic Factors Affecting Ventilation: Infections Allergic Reactions Unresponsiveness (Tongue obstruction) Extrinsic Factors: Trauma Foreign body airway obstruction

Dead Space

The portion of the tidal volume that does not reach the alveoli and thus does not participate in gas exchange

Diastolic Pressure

The pressure that remains in the arteries during the relaxing phase of the heart's cycle (Diastole) when the left ventricle is at rest.

Blood Pressure

The pressure that the blood exerts against the walls of the arteries as it passes through them.

Pulse

The pressure wave that occurs as each heartbeat causes a surge in the blood circulating through the arteries

Triage

The process of establishing treatment and transportation priorities according to severity of injury and medical need

Oxygenation

The process of loading oxygen molecules into hemoglobin molecules in the bloodstream The process of delivering oxygen to the blood by diffusion from alveoli following inhalation into the lungs

Chief Complaint

The reason a patient called for help Patient's response to questions such as "What's wrong" or "What happened" What they think the biggest problem is

Body Mechanics

The relationship between the body's anatomical structures and the physical forces associated with lifting, moving, and carrying; the ways in which the body moves to achieve a specific action.

Accessory Muscles

The secondary muscles of respiration They include the neck muscles (sternocleidomastoids), the chest pectoralis major muscles, and the abdominal muscles.

When you stand up, the weight of anything that you lift or carry in your hands is borne by:

The shoulder girdle, the spinal column, the pelvis, and the legs Try and keep it all straight and lined up Keep legs shoulder width apart (about 15 inches), and use legs to lift Vertebrae supports the lift

Glottis

The space in between the vocal cords that is the narrowest portion of the adult's airway AKA Glottic Opening

Partial Pressure

The term used to describe the amount of gas in air or dissolved in fluid, such as blood Partial pressure of oxygen in air residing in the alveoli (PaO2) is 104 mmHG CO2 enters the alveoli and causes a partial pressure of 40 mmHG

Golden Hour

The time from injury to definitive care, during which treatment of shock and traumatic injuries should occur because survival potential is best Golden Period THE BODY'S ABILITY TO COMPENSATE FOR SHOCK DIMINISHES OVER TIME

Sclera

The tough, fibrous, white portion of the eye that protects the more delicate inner structures

Capnometry

The use of a capnometer, a device that measures the amount of expired carbon dioxide

Minute Volume

The volume of air moved through the lungs in 1 minute Calculated by multiplying tidal volume and respiratory rate One of the best/easiest indicator to determine if someone is having breathing problems AKA Minute Ventilation

Alveolar Minute Volume

The volume of air moved through the lungs in one minute minus the dead space Calculated by multiplying tidal volume (minus dead space) and respiratory rate

Alveolar Ventilation

The volume of air that reaches the alveoli It is determined by subtracting the amount of dead space air from the tidal volume

Responsiveness

The way in which a patient responds to external stimuli, including verbal stimuli (sound), tactile stimuli (touch), and painful stimuli

Patients should be transported on their left side if:

They are pregnant (If they are uncomfortable)

Visceral Pleura

Thin membrane that covers the lungs

Parietal Pleura

Thin membrane that lines the chest cavity

Vocal Cords

Thin white bands of tough muscular tissue that are lateral borders of the glottis and serve as the primary center for speech production. Also contain defense reflexes that protect the lower airway

BP Cuff

Three sizes: Thigh, adult, pediatric Cuff that is too small may result in falsely high readings, and a cuff that is too big may result in false low readings Normal cuff is designed to wrap around arm 1-1.5 times

Palpate

To examine by touch IF A CONSCIOUS TRAUMA PATIENT IS COMPLAINING OF PELVIC PAIN, THERE IS NO REASON TO PALPATE- TREAT IT AS A FRACTURE

Coagulate

To form a clot to plug an opening in an injured blood vessel and stop bleeding

Ausculate

To listen to sounds within an organ with a stethoscope

Palliate

To make less severe or intense To alleviate the symptoms Treatment works by palliating symptoms

Chest Trauma

Trauma emergencies typically obstruct blood flow to individual cells and tissues: Pulmonary embolism Simple or tension pneumothorax Open pneumothorax: Wound Hemothorax: Blood in lung (Typically more below) Hemopneumothorax: Blood and air Thin,, tall, males, young, smoke = Spontaneous pneumothorax Air in lung sounds like an echo (Hyperresonant) /blood sounds solid/dull

Note

Unconscious patients with rapid or slow and shallow respirations need to receive assisted ventilations.

Short Backboard

Used to immobilize torso, head, and neck of seated patient Kendrick Extraction Device (KED): Vest immobilization device - Used move from seated to supine position

The physical act of moving air into and out of the lungs is called:

Ventilation

When a patient is not breathing we need to assess for a pulse. When a patient has neither ______________ nor _______________ we start CPR

When a patient is not breathing we need to assess for a pulse. When a patient has neither respirations nor pulse we start CPR

Structures that help us breathe:

~ Diaphragm ~Chest wall muscles ~Accessory muscles of breathing ~Nerves from the brain and spinal cord to hose muscles

In which of the following patients would a nasopharyngeal airway be contraindicated? A.A semiconscious patient with a gag reflex B.An unconscious patient with an intact gag reflex C.A patient who fell 20 feet and landed on his or her head D.An unconscious patient who gags when you insert an oral airway

C. Nasopharyngeal (nasal) airways are contraindicated in patients with severe head or facial injuries and should be used with caution in patients who have delicate nasal membranes or are prone to nosebleeds. The nasal airway is better tolerated in patients who are semiconscious and/or those with a gag reflex.

In an otherwise healthy individual, the primary stimulus to breathe is a(n): A.increased level of oxygen in the blood. B.decreased level of oxygen in the blood. C.increased level of carbon dioxide in the blood. D.decreased level of carbon dioxide in the blood.

C. Under control of the brain stem, rising levels of carbon dioxide in arterial blood normally stimulate breathing in an otherwise healthy patient.

The primary waste product of aerobic metabolism:

Carbon Dioxide

Diaphoretic

Characterized by light or profuse swelling

When possible, the secondary assessment focuses on the:

Chief Complaint

Rhonchi

Coarse, low-pitched breath sounds heard in patients with chronic mucus in the upper airways Prominent in expiration Mucus in lungs, cough common

Frostbite

Damages to tissue as a result of exposure to cold. Frozen or partially frozen body parts are frostbitten.

Residual Space vs Dead-Air Space

Dead air space is usually up in the bronchioles, not down in the lung Residual space is in the alveoli in the lungs

Kussmaul Respiration

Deep, rapid respirations Common in patients with metabolic acidosis/ high blood sugar/ kitoacidosis Body is trying to get rid of more CO2 because pH has gotten too low (Carbon dioxide is acidic)

Extra Notes

When we ventilate, we are giving positive pressure ventilations (air can build up in stomach) Patients with COPD have difficulty eliminating carbon dioxide through exhalation Pathophysiology of Respiration: Factors in the nervous system Maintaining a patent airway is critical Anemia (Hemoglobin should be around 9-14) Hypovolemic Shock- caused from blood loss Vasodilatory shock: Veins dilating To select the proper size oropharyngeal airway, you should measure from the: corner of the mouth to the earlobe Intrapulmonary shunting occurs when: blood coming from the right side of the heart bypasses non functional alveoli and returns to the left side of the heart in an oxygenated state. A nasopharyngeal airway is inserted: with the bevel facing the septum if inserted into the right nare. What occurs when a patient is breathing very rapidly and shallowly? Air moves primarily in the anatomic dead space and does not participate in pulmonary gas exchange. . Pressure regulators for Supplemental Oxygen a. Pressure regulators reduce the cylinder's pressure to a useful therapeutic range for the patient—usually 40 to 70 psi. b. After the pressure is reduced to a workable level, the final attachment for delivering the gas is one of the following: i. A quick-connect female fitting that will accept a quick-connect male plug from a pressure hose or ventilator/resuscitator ii. A flowmeter that will permit the regulated release of gas measured in liters per minute 2 treatment options: Assisted ventilation and CPAP

Nasal Flaring

Widening of nostrils, indicating that there is an airway obstruction

Blunt Trauma VS Penetrating Trauma

With blunt trauma, the force of the injury occurs over a broad area, and the skin is sometimes not broken while stuff underneath can be damaged With penetrating trauma, the force of the injury occurs at the specific point of contact between the skin and the object. Object pierces skin and creates open wound, increasing infection risks.

Jaundice

Yellow skin or sclera that is caused by liver disease of dysfunction

Important Oxygen Notes

You will get better tidal volumes with mouth to mask than with bag-valve mask, but you can get adequate tidal volume with BVM with good technique The volume of oxygen is based on observing chest rise and fall Slow and irregular respirations indicate neurological problem Squeeze breath for one second, relax for one, rest for one