EMT Exam 2

CODE LIST

Cardiac arrest = Blue - fire = red - severe weather = gray - tornado = black - missing /abducted infant = pink - bomb treat = brown - disaster = yellow - toxic exposed = Orange

General Pharmacology

Ch14 - General Pharmacology & Medication Administration

Cardiac Emergencies

Ch17 - Cardiovascular Emergencies

aha protocol

Chain of survival (adult) - early activation, early CPR, early Defib, Early ALS. - the key outcome is the AED - the most important basically Chain of survival (pedi) - prevention, CPR, activation, ALS.

heart failure

Congestive Heart Failure (CHF) - LHF = backs up in the lungs -Left side does more /more complex - More likely to get hurt by MI RHF = Backs up in the body, legs , jugular vein distention -Cause more common for damage = RSH it backs up lungs and makes R work harder Both body and lungs = complete heart failure

THE GREATER VESSELS

DONT WANT TO traumatize these - STIFF = DONT MOVE = EASY TO HUrT in truma bc they dont move - Pulmonary Vena Cava's Aorta -thoracic , Retroperitoneal cavity = saseptible -

Syrup of Ipecac

EMTs do NOt carry this but WE nEED to carry this bc given in DAYSCARES = we dont give bc we prioritize the AIRWAY • Indication: Oral poisoning or overdose. - Action: makes patient vomit in about 20 minutes. - Side Effects: none, because they are suppose to have N/V. Route: oral. Dose: 30mL in 8oz glass of water. Contraindicated: if nauseated prior to giving any charcoal, not able to follow directions or ingestion of heavy metals or corrosive substance.

Which two of the following patient populations typically require a modified drug dose?

Elderly adults., Pediatric patients - Factors that influence actions of drugs are; ["age"] , body mass (weight), and temperature along with many others. - sex, albumen levels - . Drug excretion is the elimination of toxic or inactive metabolites from the body which primarily takes place in the ["kidneys"] but can also be accomplished in the intestines, lungs, sweat glands, mammary glands. - So remember that people who have poor liver and kidney function along with the elderly have problems metabolizing (using/removing) drugs from their body.

Routes of Administration

Enteral - Gi related, PO, PR- rectal Parenteral -Anything not GI -MI, IV , Sbl, Parenteral medications are absorbed more quickly than enteral medications. Topical -On the Skin

patho of not breathing right

Epiglottitis Pertussis Cystic fibrosis Poisonous exposures - Obstructive Pulmonary Diseas

ASSIST

Epinephrine - Increases Heart rate and BP , and DECREASES muscle tone OF bronchi (some m-control have made epi something you can give) Mete-dose Inhaler -Several Medication are used to help dilate the bronchi Nitroglycerin - Increased Blood flow by RELIEVING SPAMS and causing arteries Dilation - STAY or TABLET

Obtain an Order from Medical Direction

Every medication the EMT administers, or assists the patient with, requires an order from medical direction - If you receive an on-line you must verify by repeating drug, route and dose - if outside drug bottle can be seen ask questions to determine if medication is truly theirs - Once a medication has been administered, it is important to reassess the patient - (Medical director's have a protocol for EMS not being able to reach online medical control. Typically, if you can't get a hold of medical control with dispatch relay, two attempts to call/radio, or takes longer than 2 minutes for the doctor to get to the phone then the order is approved.) -A 31-year-old female is experiencing an acute asthma attack. She is conscious and alert, but in obvious respiratory distress. After assisting her with her prescribed MDI, you should: -contact medical control and apprise him or her of what you did.

hyperoxia

Excess oxygen or higher than normal partial pressure of oxygen -

Aspirin (ASA)

Generic Name: acetylsalicylic acid (pronounced ə-SET-əl-sal-i-SIL-ik, abbreviated ASA). Trade Name: Aspirin, St. Josephs, Bayer, and many others. Indication: MI. Action: slows platelet clumping therefore reduces vessel blockages, reduces fever, pain, headaches and sore throat pains. Side Effects: bleeding. Route: oral - chew and swallow. Dose: 325mg in emergency. 82mg if taken daily if recommended by doctor. Contraindicated: allergic to ASA. No ASA for kids under 12 years of age with a fever present. (may have a viral infection- which aspirin can cause complications) - - -EMTs do not administer it for its analgesic (pain relief)

Activated Charcoal

Generic: Activated Charcoal Trade: ActiDose and many others. -SuperChar, InstaChar, Actidose, LiquiChar (when indicated must be given Within the FIRST HOUR of OverdoSE) - have harmful effects if aspirated. Indication: oral overdose/poisoning. ---of a SOLID (PILLS)- NOT LIQUID FORM - AND DOES NOT BOND TO Heavy Metals = its a aDsorbs = atoms (Ions/molecules) ADHERE to it= so that it wont be absorbed =IT bonds to the things ingested -NOT aB(b)sorbs = a fluid is dissolved Action: stops absorption (through abhearing) of substance thru GI track. Side Effects: tar stool, N/V. Route: Oral. -= Orogastric or Nasogastric - Depends of gag or no gag -= soda may or maynot help Dose: Suspension 25 to 50 grams or .5 to 1 gram/kg. - same as glucose = 1-2 bottles (If the patient vomits the first dose may give once again.) - charcoal slows GI activity = Some Sorbitol will make move charcoal = Charcoal is indigestible Contraindicated: if nauseated prior to giving any charcoal, not able to follow directions or ingestion of heavy metals (iron, zink, vitamins) or corrosive substance (gasoline, petroleum, ACIDS, BAses,). BUT - IF BECOME NAUSEATED AFTER giving med THAN YOU CAN GIVE AGAING Wont work with TYLENOL = but we will still give

Albuterol

Generic: Albuterol Trade: Ventoin, preventil, and many others. Its a Beta 2 drug with Beta 1 SIDE effects = thats why you get anxiety/gittery - BETA 2 AGONIST! =bc it helping/respoding/Creating the REACTION -(BTW= beta blocker (block key) = beta ANTAGONIST) (you wount want to give beta antagosnit to asma patient) Indication: dyspnea to - broncoconstriction bronchospasms or congestion. Action: B2 dilates smooth muscles of lungs. -but has B1 side effect Albuterol Side Effects: anxiety, tachycardia, hypertension, shaking, nausea, vomiting, sleeplessness, dry mouth. Route: MDI (pt with COPD see alot) or Nebulizer. Dose: MDI total 180mcg or Nebulizer 2.5mg in 3mL.( takes up to 10 min) Contraindicated: none in emergency. - Metered-Dose Inhaler-=A non-betá medication that the patient may also have as an MDI is Atrovent (ipratropium bromide). This medication blocks the parasympathetic nervous system's == Combivent, DuoNeb (brand names)

Epi-Pen

Generic: Epinephrine Trade:Adrenalin . (most medicla director allow met to carry epi) - Adrenalin= EpiPen, Auvi-Q auto-injectors Indication: Severe allergic reaction. = We wait till the severe reaction- happens= start swelling up = (card to swallow) Dyspnea and lowering Bp. === immune response that can easily lead to death. The patient's blood vessels dilate (vasodilation), decreasing the blood pressure and perfusion; the bronchioles constrict (bronchoconstriction), increasing the airway resistance and making it difficult to move air into the alveoli; and the capillaries leak fluid out (from increased capillary permeability), causing the blood volume to decrease = bronchoconstriction = or bronchospasm.=Bronchospasm (constriction of the smooth muscle in the bronchi and bronchioles) - ONLY LAST 20 min - need to carry 2 ALLERGIC REACTION = IMMUNE SYSTEM is triggered to attack the body The levels to an allergic reaction =MILD, MODERATE, SEVERE (anaphylactic response) What makes it a severe = affects the circulatory and respiratory Action: increase heart rate and dilates lungs. B2 B1 drug. ---Works on B2 B1 receptors in the cell (respond to Epi) B2 = affects lungs = Bronchodilator B1 = affects heart = Faster and harder heart action -(remember beta blocker) =beta = apart of the sympathetic NS Side Effects: tachycardia, anxiety. Route: IM Lateral thigh. (we stick it in and hold for 10 sec) Dose: .3 adult .15 pedi. ADULTS = 66 pounds and older Contraindicated: none in emergency. Epinephrine •Mechanism of action:​ •Stimulates Alphā, which increases BP​ (pretty sure due to Vasoconstriction) •Stimulates Betā, which increases HR​ •Stimulates Betá, which promotes bronchodilation - -Epinephrine constricts the vessels ( alphā and alphá), increasing the blood pressure; - decreases capillary permeability ( alphā and alphá ), reducing the leakage of fluid. ---AFIL=== In particular, patients who have taken tadalafil (Cialis), vardenafil (Levitra), or sildenafil (Viagra) within the last 48 hours should never be given nitroglycerin. The combined blood-pressure-lowering effects of the nitroglycerin and the erectile dysfunction medication may cause drops in blood pressure and perfusion serious enough to lead to death. = emplation

Nitroglycerin

Generic: Nitroglycerin Trade: NitroStat, Nitro Paste, and many others -Nitrolingual Spray - Always wear gloves = nitro goes through skin -Nitroglycerin Sensitive to light Indication: chest pain Action: smooth muscle dilator (blood vessles), dilated coronary vessels. Side Effects: head ache, bitter taste, burning under tongue. -sensitive to light = no bitter taste = not work/expired +(call 911 right away) =Sensitive to light and must remain in original container =NEED TO CHECK EXPERATION =+ Tables only last 2-3 mouths when opened = 1-2 squrts = under thong = 0.4 mg Route: Sublingual - tablet or spray Dose: 0.4mg every 5 minutes up to three times. ==AS YOU WAIT FOR THE 5 MIN FOR THE NEXT DOSE YOU NEED TO RE-CHECH VITALS = you need to calculate is the next dose will put you under the the 90 SYSTOLIC based on the recorded DIFFRENCE IN THE BP from the dose -ex- 140 sys + 1 dose = 120,,(5 min wait) 120 + 2 dose = 100 sys = DO NOT GIVE 3rd dose = bC it will fall below to 90! Contraindicated: BP less than 100mmHg. - = 90mmHg = Absolute contraindication -= or a systolic blood pressure that drops greater than 30 mmHg from the baseline blood pressure. - = dilates the blood vessels in the body, causing a reduction in systemic vascular resistance. This reduces the workload of the heart = the major side effect of nitroglycerin is hypotension BP=CO×SVR - Nitro will make the BP go down resulting in the heart rate to go higher to compensate. Contact medical control if pt is has tachycardia.

Oral Glucose

Generic: Oral Glucose (different ones has amounts) Trade: Glucose and many others - Glucose is a simple sugar that is readily absorbed by the bloodstream. -put in oral glucose membrane = through the mucus of the mouth -Not a fix live dextrose in through IV = just kept them from having a seizure Indication: Low glucose levels = The signs and symptoms of a low blood glucose level will appear very rapidly. If the level drops too low for a long period of time, the brain cells can actually die. Action: increases blood sugar in blood stream Side Effects: none in emergency Route: mucus membranes Dose: 25 to 50 grams = .5 - 1 grams per Kilogram = 1-2 tudes - Rectal = 2-4 25 to 50g (or 1 to 2 tubes) (tubes not bottle) Contraindicated: not given if nauseated (we just loaded it up for emesis - Sugar in lungs= bad) , confused to when the patient cannot follow directions. = cant shallow -we can give if their

What divides the upper and lower respiratory system?

Glottis Vocal cords /glottic opening (larynx)

A 4-year-old female patient is having great difficulty breathing. She is responsive to verbal stimuli and has an open airway. Her respiratory rate is 40 breaths/min, and she has an SpÓ reading of 88%, which has dropped from 90% despite high-concentration oxygen through a pediatric nonrebreather mask. Her pulse is rapid, and her skin cool to the touch. As a knowledgeable EMT, you would recognize these findings as associated with which condition?

Group of answer choices= Respiratory distress Cardiopulmonary arrest Respiratory arrest Respiratory failure

DRUG TERMS

Indication - when to give the drug. ["on"] label- Label use - (whats its been studied for) = Rogaine - studied to lower bp (label) but not is for hair growth (off label) - Off Label use - - The new found alteration use = BOTOX - used to stop sweating , ticks, = but now used to get rid of wrinkels Action - what the drug does to the body. = Therapeutic effects -ex=Albuterol - = Broncial Smooth muscle relaxation / dilation Dose - amount to be given. - Total dose - Maxis dose - Single dose - Multi dose (some drugs have bad side effects if not given enough) Dose has many meanings; the ["maximum"] dose is to total amount which may be given. The [ ] ["single"] dose is the amount to be given per dose. Contraindication - harmful or fatal if given. Do not give. - Relative ContraIn Judgement call - gray Giving Nitro at 100 systolic - Absolute ContraIn -absolutely don't do it = lawsuit -Never give Nitro at 90 systolic = SHOCK = Hypo-perfusion = not enough to get circulation Side effects - a known effect that has nothing to do with the reason for taking the drug. - WhyoFED, SudaFED = used for congestion = causes HEART palpitation -ALLEGIC - Unexpected side effect = -causes serious systemic effect -UPTOWARD/Adverse effect -med that triggers immune system to attack yourself -===An adverse reaction to an untoward effect is categorized as being [ ] ["allergic"] to it which may include systemic hives and difficulty breathing.

insert lung sounds stufff

(never auscultate over clothing), fine crackles (rales) - short popping sound heard during inspiration. Usually heard at the bases. Inhaled air suddenly opens small deflated air passages (alveoli). - PULMONARY EDEMA - Coarse Crackles (Coarse Rales) and wheeze =loud, low pitched, bubbling; may clear with coughing, but reoccur shortly; (sound like Velcro); - rhonchi with wheeze =Cystic Fibrosis - Cheyne-Stokes- Periods of difficult breathing (dyspnea) followed by periods of no respirations (apnea) Indicates brain stem injury -- shallow, deep, shallow, stop - Kussmaul respirations =very deep, labored breathing, fast (usually associated with diabetic acidosis and renal failure) -flowing off sugar -DKA present. Grunting =An "uh" sound heard during exhalation; reflects the child's attempt to keep the alveoli open; a sign of increased work of breathing. - Trying to keep air in longer before exhaling eupnea normal breathing

asthma

-Asthma attacks are often categorized as being mild, moderate, or severe- status asthmaticus. =true medical emergency= rapid transport to the hospital. = May be caused by severe emotional stress, exercise or respiratory infections - Asthma patients usually suffer acute, irregular, periodic attacks, but between the attacks they usually have either no or few signs or symptoms - Extrinsic asthma, or "allergic" asthma, It is typically seasonal, occurs most often in children, and can subside after adolescence. Intrinsic, or "nonallergic," asthma is most common in adults and usually results from infection, emotional stress, or strenuous exercise. -In asthma, the smaller bronchioles tend to collapse when the lungs recoil; therefore, exhalation is more difficult and prolonged, and air becomes trapped in the alveoli. Because of this, wheezing is heard much earlier upon exhalation - Pulsus paradoxus (drop in systolic blood pressure of [ ] during inhalation) Indicates a severe asthma attack. - Approximately 80 percent of the cases of asthma have a slow onset (referred to as slow-onset asthma) with deterioration over a minimum of 6 hours to several days. (ussulaii un woman) -usually triggered by an upper respiratory tract infection. - Sudden-onset asthma occurs in approximately 20 percent of cases and presents with rapid deterioration within the first 6 hours after onset. This type occurs more often in males- -usually triggered by allergens, exercise, or stress =likely to die from this asthma event. - Keep in mind that if a patient's symptoms have occurred over several hours/DAYS you should be prepared for this patient to develop respiratory failure or even respiratory arrest. - Humidification of the oxygen is not necessary; however, it might be helpful in rehydrating the airways. - When providing positive pressure ventilation to a patient suffering a severe asthma attack in respiratory failure or arrest, the increase in resistance in the bronchi and bronchioles makes ventilation more difficult to perform.

What three drugs, that an EMT is familiar with, are contraindicated or require online medical control to give if the heart rate is excessively tachycardic?

-Epinephrine -Nitro -Albuterol

HOW TO GIVE DRUGS

-OBTAIN ODER FROM DC / MEDICAL CONTROL =Get order and repeat word by word. to the DC /verify = Ask Patient 1)if ok to give, 2) if they have allergies, 3) if they have had any lately. - = 5 "rights". -VEFIFY PROPER MED AND PRESCRITION -CHECK THE RIGHTS = FORM , DOSE, ROUTE - CHECK experation date and CONDITION OF MEDS - 1 re-check = at least once before giving drug. = Reassess VITALS AFTER EVERY administration of Meds - DOC any med given AND any changes in PT condition

Kussmaul sign

-⬆ in JVP on inspiration instead of a normal decrease

high vs low blood sugar

70 or LESS THAN - Low = blurred vision , weak , confusion , hunger, high BP, seizure, fainting , LOW BRAIN FUNTION - Hypogly - brain will DIE = cool, PALE , Sweaty or clammy , - H-eadache I-rritable W-eakness A-nxious and trembling S- weaty , "diaphoresis" H- unger high - hyperglycemia , sugary breath/acid , sugary urine, blurry wound healing , = over 115 - stress makes it higher PolyUria - too much urine Polydipsia - too much Drink PolyPhaGia - too much plates = Hunger

Chronic asthma

=ASTHMA IS A REVERABLE NARROWING OF LOWER AIRWAY =Lower airway reversible narrowing -50% of patients who die from asthma do so before they can reach the hospital. Think of asthma as not one attack but rather two attacks. CAUSE BY A TRIGER = perfume , Pollen , Dry airway , Dust , Smoke , stressful situation , COLD Weather - Anyone can have a ashtma attack /acute under the right condition -but copd have it alot = Asthma patients are typically younger and, unlike emphysema and chronic bronchitis - Today, asthma is considered to result primarily from inflammation of the lower airways, which can lead to airway hyperactivity, resulting in bronchospasm- inflammation of the bronchi and bronchioles lead to obstruction of the lower airway and high airway resistance. -Therefore, asthma is considered an obstructive pulmonary disease but is not categorized as a chronic obstructive disease (COPD). - THE LONGER EXPOSEd TO IRRANT THE WORSE THE ATTACK CAN BE - it can kil u -(diffrent from alleergic reaction) 1st goal = LIMIT time expose to irritant - ASMATH attack have to 2 ATTACKd - if you aggresive eoth the fosrt one it can hinder the 2nd one from happeninf 1st attack - must have a trgger ---= constriction - get rid of trigger = fist goal = bronchioles CONTRACT AND MAKE lumen IT SMALLER and dry up LUNGS - WOrse type of aastham is whne you cant hear nothning = We need to give bronhco Dilator & Streroid - SPOTS secreation/immune system = bc lungs driyed out it sends fluid and its too mmuch and also trugger acts acts as antigen 2 attack = Since body is sending immune respose and it sends liquid - THE SECOND ATTACK COME WITH FLUID/ !MUCUS? & constriction (continuation of it) - steroid takes hours to work - 2nd is harder no manage bc it has to due wiht edema where as the 1st is just muscles -

stimulus to breathe is triggered by low oxygen levels in the blood. This is known as the ___________.

=hypoxic drive when mouth to mask is not available to ventilate patient = -Two-person BVM with 100% oxygen - lung compliance =The ease at which the chest expands Good flow of air in and out of the body.

Metered-Dose Inhalers and Small-Volume Nebulizers

A bronchodilator by MDI or SVN should not be given if any of the following conditions exist: The patient is not responsive enough to use the MDI or SVN. The MDI or SVN is not prescribed for the patient or is not in the EMTs protocol./ Mcontrol say no -If the patient has breathing difficulty that is not related to trauma or a chest injury, and has one of the beta 2-agonist bronchodilators in an MDI form prescribed to him by a physician, you should contact medical direction for permission to administer the drug or follow local protocols. -During the administration, you must coach the patient to breathe in slowly and deeply, to hold his breath as long as he comfortably can, and to breathe out slowly through pursed lips - drug that is commonly prescribed asthma is the Advair Diskus -is a long-acting beta 2-specific drug -also contains a steroid Age-Related Variations -Pediatric Patients =Because infants and children generally have healthy hearts, respiratory failure is the most likely cause of both respiratory arrest and cardiac arrest. -Typically, signs and symptoms of respiratory distress precede respiratory failure in the infant or child. -respiratory distress might quickly proceed to respiratory failure in the infant or child - The chest wall is extremely pliable(flexible) in infants and young children, and the intercostal muscles (muscles between the ribs) are not well developed. Therefore, the child relies heavily on the diaphragm and abdominal muscles to breathe =early in respiratory distress when they begin to use the intercostal muscles to assist in breathing. -s&s = bad = Loss of muscle tone (limp appearance) -Head bobbing (bobbing of the head with each breath) -Grunting (heard in infants and children during exhalation, indicating diseases that produce lung collapse) -Seesaw or rocky breathing (The chest is drawn inward and the abdomen moves outward, indicating extreme inspiratory efforts.) -Decreased response to pain = Allow the child to assume a position of comfort to reduce the work of breathing- =breathing becomes inadequate (respiratory failure), remove him from the parent, establish an open airway, and begin positive pressure ventilation with supplemental oxygen. -Only infants and children would require the use of a mask with an MDI or SVN. Croup (laryngotracheobronchitis), commonly seen in children, involves the swelling of the larynx, trachea, and bronchi, causing breathing difficulty -At night, the condition usually worsens. -Provide oxygen to the patient, humidified if possible, and begin transport - Geriatric Patients =elderly already have diminished respiratory function. = RR^ normally -The signs and symptoms of respiratory distress usually briefly precede respiratory failure in geriatric patients. -not have the compensatory mechanisms younger adults have and typically decompensate rapidly -s&S Prolonged exhalation (with pursed lips) -This means it is difficult for the geriatric patient to move the rib cage during periods of heightened respiratory effort. The result is more reliance on the diaphragm and abdominal muscles to breathe. -Retractions in an adult or geriatric patient with respiratory distress are a significant sign of severe respiratory distress. General Guidelines -respiratory arrest usually follows shortly after development of severe fatigue. -Diaphoresis.=The patient becomes more diaphoretic the harder he works to breathe. - Hypoxia causes the patient to become agitated and aggressive. Hypercarbia causes confusion, disorientation, and lethargy. -Pale, cool, clammy skin is an early sign of hypoxia in the patient. - 12-20 breaths per minute; however, it is possible for the patient with lower or higher rates to be breathing adequately - During your assessment, you can summarize the patient's respiratory status as follows: One inadequate (either rate or tidal volume)=inadequate breathing.(either rate or tidal volume) Two inadequates (both rate and tidal volume)=inadequate breathing.(both rate and tidal volume) Two adequates (both rate and tidal volume) - (bradycardia) with breathing difficulty, and an altered mental status. -cyanosis is an ominous and late sign of respiratory distress, as is a slow respiratory rate. Pulmonary Embolism -Jugular venous distention Lower leg tenderness, pain, redness, and did he have an endotracheal tube placed down his throat to breathe or require admission to an intensive care unit? This usually indicates that the patient may deteriorate more rapidly - Assess the neck for jugular vein distention (during the inhalation phase of respiration), which might indicate an extreme increase in pressure in the chest or venous system. Inspect and palpate for an indrawing of the trachea and tracheal deviation. tracheal deviation -result of an extreme amount of pressure built up on one side of the chest, collapsing the lung and pushing the mediastinum =and the trachea to the opposite side. This is a sign of a life-threatening emergency. subcutaneous emphysema, which is air trapped under the subcutaneous layer of the skin. =indication that an air leak is present somewhere in an air-containing structure in the neck or chest. . Wheezing is heard primarily during exhalation. -rhonchi are sounds heard in the larger airways and represent mucus accumulation. Vital Signs -The systolic blood pressure can drop during inhalation =This is related to a drastic increase in pressure inside the chest =auscultation, watch the needle when obtaining the systolic pressure. =If the needle suddenly drops more than 10 mmHg when the patient inhales, it is pulsus paradoxus (as noted earlier), which is a significant finding of a severe respiratory condition such as obstructive lung disease\= = how? - . If the pulse oximeter reading is below 90 percent, this is a significant indication of severe hypoxemia.

. You would integrate your ventilation into the patient's spontaneous pattern and rate of breathing to produce an effective rate and tidal volume. Do not hesitate to ventilate a spontaneously breathing patient who has an inadequate rate or tidal volume.

A poor SpÓSpÓ reading can assist you in making the decision to ventilate. For example, if a patient were breathing at 38 times per minute with a shallow tidal volume and has an SpÓSpÓ of 88%, you would immediately make the decision to ventilate the patient with a bag-valve-mask device. You would ventilate at 10-12 times per minute, adding your ventilation to the patient's spontaneous breathing. -A severely hypoxic patient might not complain of extreme shortness of breath. Pay close attention to your assessment findings. =btq- Paradoxical motion, in which an area of the chest moves inward during inhalation and outward during exhalation (a sign of significant chest trauma; can lead to ineffective ventilation) - Moist skin (diaphoresis) is a result of the sympathetic nervous system response in the patient with breathing difficulty.

Small-Volume Nebulizer

A respiratory device that holds liquid medicine that is turned into a fine mist.

what cells from the pancreas make insulin

BETA CEELS - INSULN puts sugar and K in the cells = so - in the blood = low sugar and K ------ beta males need insulin

Melena

Black tarry stool

DRUG ROUTES

Intravenous (IV) - Fastest and most accurate/RELIABLE way to get a drug into circulation. -bypass liver Intramuscular Injection (IM) - needle placed in middle of large muscle. Needle is 90 degree angle to the skin. = need to use long needle -middle of the muscle which allows for up to 2-5 mL. Subcutaneous Injection (SQ or SubQ) - Drug delivered in fat layer. Needle is 45 degree angle to the skin. -not as fast as IM -designed to produce a slower absorption rate than intramuscular injections; - typically does not exceed ["one"] mL. Oral (po)- (npo = Nothing by mouth) most medications take 20 to 30 minutes to see benefits. Some drugs like Tylenol and alcohol are absorbed very quickly. - Drugs mixed with Fat, Sugar, or Etoh, enter faster Per Rectal (PR) - Liquid or gel form medication. Benefits in about 30 minutes. -Anything you can put into your mouth you put into your mouth butt = BUT because of rectal stuff and adsorption stuff - =YOU DOUBLE THE DOSE OR MORE-(from a normal mouth dose) = may be needed for seizure or throwing up Sublingual - easy to give and relatively fast. = Minutes into circulation. -Nitro = pass liver -==mucus membranes =in the mouth Most sublingual drugs are ["cardiac"] related. -The patient does not swallow the medication. Inhalation - second fastest into circulation. -= This method typically deposits the medication directly to the target site where the effect is needed most. - which include Ó and laughing gas known as ["nitronox"] - SUB -- Intranasal. The medication is sprayed into one or both nostrils using a specialized delivery device called a mucosal atomizer device (MAD) Intraosseous (IO) Needle into bone marrow of long bone. Just as fast as IV. =Used most commonly on small children Topical- Transcutaneous - placed on the skin - a patch.= transDermal patch

Levalbuterol

It can treat or prevent bronchospasm.

new version of albuterol

Levalbuterol = Xopenex trade -= Combivent, DuoNeb

What makes a Drug A drug

Medication: Substances used for medical treatment - Drug: Substance that has Physiological Effect. WHAT HAS TO HAPPEN FOR FDA APPROVAL Has to do one or more; Treat - Anti-B Prevent - Vac Diagnose - EX-Color, clean colon - United States Pharmacopeia - Generic names of drugs and official list of drugs. Like an encyclopedia

NEW SECTION

NEW SECTION

STATUS ASTHMATICUS

NOT be BROKEN BY NORMAL MEAND EX- humidifier bronchidilatiors , streroids, a severe, life-threatening asthma attack that is refractory to usual treatment and places the patient at risk for developing respiratory failure.

NARCAN

Naloxone Hydrochloride -Narcan- is used to treat a known or suspected opioid overdose. Common opioid analgesics:​ •Codeine, fentanyl, hydromorphone, meperidine, methadone, morphine, oxycodone​ - Fentanyl is 100x more potent than morphine and is dosed in mcg, not mg. Hydromorphone is 7x more potent than morphine =Naloxone is a competitive opioid antagonist that competes for the same receptor binding sites as the opioid drug. = binds to opioid receptor sites, it effectively blocks -Narcan suddenly reverses respiratory depression, hypotension, and any sedative effects created by the opioid overdose. -Depending on the dose and route of Narcan and the opioid that the patient overdosed on, the opioid may stay in the body longer than the Narcan -ome opioids, such as fentanyl or carfentanil (carfentanyl), are potent and may require several repeat doses of Narcan to reverse the respiratory depression, hypotension, and sedative effects Carfentanil is a synthetic form of fentanyl that is 10,000 times more potent than morphine and one of the strongest opioids -Narcan itself has no effect on a patient unless an opioid drug is currently in the person's system. Therefore, it is a relatively safe drug to administer in either suspected or known heroin or other opiate drug overdoses.

DRUG NAMES

PERSCRITION -given by pharmacist according to MDs order Over the Counter - Available Without a Prescription -Tylenol = Claps alot people (maybe the most) Generic - lots of letters. First letter should be lower case. / all SHOULD have lower case -Official name that nurses use -Must always have generic name Generic name is always listed with a trade name, if trade name is available. = easier form of chemical name -acetamatafine -bifenhiramine Trade Name - -UPPER CASE letters - given by a manufacturer. Lots of marketing so people can remember it and it's use. -Tylenol

CAUSES OF DYSPNEA

PULMONARY EMBOLISM -PE -STOPS BLOOD FLOW to lungs NOT AIR S&S Sudden, Tachypnea, cyanosis, CHEST pain , hemoptysis, -Sudden onset Dyspnea. -Common types of clots; air, fat, amniotic fluid, blood clots HIStORY gives it aways = Surgery, Childbirth, smoker/ nicotine, On girt control -prolonged immobilization like travel. A-fib and sickle cell also can increase the occurrence of a PE. PlACE ON LEFT SIDE = HEART STAYS low= if air is the cause - it will say up-there, ---- THere are tother pt we put on side -pregnant -PE -Spontaneous breathing (no spinal injury) Embolism/EMBOLI = A moving blockage - blood clot, fat, air ..ets - can go to brian , heart, lungs Thrombosis = NON-moving blockage - A PE move to heart causing a __________________________ (MI), the brain causing a _________________ (CVA) or in the calf known as a ______________________________ (DVT)

Other Conditions That Cause Respiratory Distress

Pneumonia =HIV) and others who are on immunosuppressive drugs, such as cancer or transplant patients, are also prone to pneumonia. =exposure to cold temperatures. -Altered mental status, especially in the elderly =managed no differently from any patient having difficulty in breathing. - is not usually associated with severe bronchoconstriction, unless it occurs as a complication of asthma or COPD - beta 2 agonist medication = would not consider their use unless indications of bronchoconstriction are present.- --- Pulmonary Embolism =long periods of immobility -well as those with heart disease, recent surgery, long-bone fractures , preg , cancer -blockage of blood flow through a pulmonary artery or its branches. =(reduced perfusion). Based on the ventilation/perfusion ratio, =a sudden onset of unexplained dyspnea and chest pain -and signs of hypoxia,= Cough (might cough up blood)=Syncope (fainting) Cool, moist skin - Decrease in blood pressure or hypotension (late sign) Cyanosis (might be severe) (late sign) Distended neck veins (late sign) Acute Pulmonary Edema -typically related to an inadequate pumping function of the left ventricle -Noncardiogenic pulmonary edema, also known as acute respiratory distress syndrome (ARDS), ==Severe pneumonia, aspiration of vomitus, submersion, narcotic overdose, inhalation of smoke or other toxic gases, ascent to a high altitude, sepsis, and trauma. =CPAP and positive pressure ventilation work by increasing pressure on the alveolar side and preventing more fluid from entering the alveoli. -Crackles (also called rales) are a sign of pulmonary edema. -CPAP can be extremely beneficial in the acute pulmonary edema patient in respiratory distress or early respiratory failure who is awake, alert, oriented, and can obey commands (GCS>10) Spontaneous Pneumothorax =sudden onset of shortness of breath with decreased breath sounds to one side of the chest and no evidence of trauma -visceral pleura ruptures without any trauma having been applied to the chest. =disrupting its normally negative pressure and causing the lung to collapse. =Primary spontaneous pneumothorax occurs in patients in their teenage years to early 20s who are tall and thin = Secondary spontaneous pneumothorax. Occurs in patients in which there is underlying lung disease. Cyanosis (can be seen late and in a large or tension pneumothorax) Positive pressure ventilation in pneumothorax must be performed with great care because the could easily be converted into a tension pneumothorax Hyperventilation Syndrome -EMS personnel often overlook significant and potentially life-threatening conditions, -One result is that the amount of calcium decreases, = muscles of the feet and hands to cramp. =caused by a drastic reduction of carbon dioxide. - This causes the cerebral arteries to constrict excessively, -Remove the patient from the source of anxiety or remove the source of anxiety from the scene, Epiglottitis -Epiglottitis, an inflammation affecting the upper airway, can be an acute, severe, life-threatening condition if left untreated. -Inability to swallow with drooling (late sign of impending failure) = Inspiratory stridor is an indication of an almost completely occluded airway. It is created when the patient breathes in sharply to draw air past the airway obstruction =narrowed glottic opening, airflow becomes turbulent and creates the high-pitched sound. = ["stridor"] indicates an partial upper airway obstruction heard of inspiration. Pertussis Pertussis (also known as "whooping cough") is a respiratory disease that is characterized by uncontrolled coughing. It is a highly contagious disease -caused by bacteria -most reported in children. -followed by a "crowing" or "whooping" sound made during inhalation as the patient breathes in deeply. =Inspiratory "whoop" heard at the end of coughing burst -Most deaths occur to younger patients who have not been immunized for this disease, Cystic Fibrosis -is a hereditary disease. -y causes pulmonary dysfunction because of changes in the mucus-secreting glands of the lungs, it also affects the sweat glands, the pancreas, the liver, and the intestines. -die at a young age (20s to 30s) because of pulmonary failure. -This mucous lining is normally watery and helps to warm and humidify inspired air. It also serves to trap any inhaled particles. In cystic fibrosis = does too much -Repeated lung infections cause scarring -many of the other findings in pt are due to dysfunction of other organ systems. -Poisonous inhalation injury is an umbrella label for any type of inhalation injury that occurs secondary to exposure to toxic substances that can cause airway occlusion and/or pulmonary dysfunction by inhibiting the normal exchange of gases at the cellular level. -They can cause the soft tissue that lines the upper airway to swell to the point that airway occlusion occurs -most important primary treatment is to limit the exposure if the patient is still in the toxic environment. Viral respiratory infections are commonly referred to as upper respiratory infections (URIs) -The VRI typically runs its course in approximately 14 days- - Metered-Dose Inhalers and Small-Volume Nebulizers- --The medication is dispensed as an aerosol, or mist, that the patient inhales -compressed air or oxygen converts it into an aerosol mist. -They are beta 2 agonists, which mimic the effects of the sympathetic nervous system. = Most bronchodilators begin to work almost immediately, and their effects can last up to 8 hours or more

Drugs that A EMT can Give

Responsible for administering Ó - (NEED prescription to refil) Glucose - rectal & oral (SIMPLE SUGAR) Charcoal - Oral Responsible for ASSISTING (already prescribed) pt -Even when assist we might need to ask Mcontrol for permission Albuterol - EPI-PEN Nitro - (Your Medical Director can expand this list BTW) - =naloxone hydrochloride. - As an EMT, you will administer medications under the direct order of a licensed physician. Without this order, you cannot administer any type of medication - Remember that you may not administer or assist with administration of any medication other than the medications that are identified in local protocols - EMT need to use their judgment -

Third intercostal space, =anterior axillary line, or fourth intercostal space, midaxillary line

Sounds heard here represent airflow through smaller conducting airways (bronchioles). You might also hear some airflow into the air sacs (alveoli). The abnormal breath sound heard best in this location is wheezing.

Artificial Ventilation

Stop Breathing or any one who cannot maintain oxygen levels. Less than 8 or over 30 (with poor patient presentation) ventilations per minute need artificial. Override breathing - when patient breathes in provide greater tidal volume.

Heart Anatomy

Superior vena cava= bring blood from above nipple lime - VEINs = bring blood to the heart -have valves = low pressure Artery = move blood away its easier to bring 2 flaps than 3 = mitral in LV

DRUG FORMS

Tablet / PILL- powders pressed to pill form. - Nitro = Pill - solid sheet of drug cut into easy to swallow shapes. Like minerals and vitamins - a "horse" pill because it is large. Caplets = hybrid Capsule - (could be the Gelatin SHELL with powder or LIQUID) a carrier with drug inside. Helps for time delay or taste Sublingual Spray - Liquid spray placed under tongue Suspensions - two liquids that separate. Different particles in water mixture = ex= oil and water - Need to be shaken first.= Chaicoal, MDI (MOST OF THEM), Albuterol Solution - Liquid mixture of one or more substances ---HOMOGENEOUS = 2 most common - LR= Lactated Ringer - NS = Normal saline = An IV bag of 0.9% Sodium Chloride/ mixture of one or more substances. Topical - medication - Lotion, creams, ointment, applied to skin. = SILVADENE cream= For serious burns Gases - like oxygen. -Nitros Oxide = laughing gas Transcutaneous Med - Transdermal designed to be absorbed through skin -birth control patches and motion sickness patches - -Gels - Liquid/gel form. - ig some can be given though the skin

Pharmacology

The study of body functions to chemical changes.

Drug Names

There are ["four"] common categories of drug names (EMT will focus of three). "trade/ BRAND] name is assigned to foster brand loyalty amount its customers or is a catchy name to allow customers to remember it or associate with it. The official name is the acknowledged name by the FDA and listed with the letters [ ] ["USP"] which stands for the United States Pharmacopeia. Chemical name. The chemical name describes the drug's chemical structure. Generic name. Also referred to as the nonproprietary name, still reflects the chemical characteristic of the drug, - All the same drug: Trade: Tylenol Generic: acetaminophen Official: acetaminophen, USP

titrate

To determine the concentration of a substance

notes from book

Ventilation - chest movement. Respiration - air in and out of cell and tissue . Cell levels ABG - arterial blood gasses - take blood an analyze it of saturation. - Dyspnea - difficult breathing. - Terms: Seesaw, nasal flaring, tripod, sniffing, wheezing, rales, rhonchi, stridor, gurgling, snoring, unequal chest rise, no chest rise. - Adult 12-20, Child 15-30, Infant 25-50 Should be quiet, effortless with equal chest rise.

lung diffusion in cellular level

WE hve 3 sections to lung diffusion = move by diffusion - -Alveoli -WE have pressure at in the lungs too -we have có and Ó -interstitial space/rd spacing -is a liquid filed area -capillary =hydrostatic pressure -- effected by BP -we have có and Ó IF we have alot of pressure in the lungs = goes into the aveli - we normally have liquid going into the lungs all the time = === so how do we fix it - Albumen (protein made by liver) increases the concentration (creating normal blood serum-between levels) increasing osmotic pressure with absoves water - = We do it by lower - PULMARY blood pressure/ lower the hydrostatic pressure of BV (which is pushing the water out (sysytemic is seperate from pulamary blood pressure) or Increasing pressure in the lungs - by intubating in the lungs and having constant pressure in the lungs pulmanry edema happen by water going to bood vessle and then 3rd space and the lungs

Fifth or sixth intercostal space, posterior mid-scapular line

While the patient is sitting upright, the sounds heard here represent airflow into the alveoli. This is the best location to hear alveolar airflow. The abnormal sound heard here most commonly is crackles (rales).

what happens when you over ventilate

Your assessment reveals that he has a barrel-shaped chest, unilaterally diminished breath sounds, and tachycardia. - Spontaneous pneumothorax =Emphysema weakens the lung tissue which can lead to tearing of the visceral pleura. Unconscious choking is preformed the same as CPR but we add in oral visualization to look for the object before we ventilate. the person is too large to reach around their abdomen for abdominal thrusts. You should? =Move your hands up to the victim's chest and do chest thrusts from behind During your assessment, you find that your pulse oximeter (SpO2) reads 100% when your patient is on 4 liters per minute oxygen via nasal cannula. =Turn the LPM down until you bounce between 98 and 100% =Too much oxygen to injured tissues/cells kills them. That still give oxygen but get off the 100% number. What will happen to cardiac output as a result of over ventilating the patient? -Cardiac output goes down (Tv - VD) x RR = Mv -Amount of air moved/exchanged in 1 minute = ["tidal volume"] is the volume of gas inhaled or exhaled during one breath, which in adults in normally 500 to 600 mL. =["minute volume"] is the amount of gas inhaled or exhaled in one minute. -Hypoxemia: = 1st = abnormally low oxygen in the blood (This material was covered in physiology. See what you can remember.) We have chemoreceptors located in the ["carotid bodies"] and ["aorta"] which register the levels of ["oxygen"] in the body and is know as the [ ] ["hypoxic drive"] . The chemoreceptor within the ["medulla"] registers ["CO2"] and is the normal stimulus for respirations in a health person. - The ["phrenic"] nerve which leaves the spine at C4-5 controls the diaphragm. - The ["vagus"] nerve inhibits the lungs and is responsible for what is known as ["negative feedback"] . When the lungs are full the nerve tells the medulla to stop the stimulus to inspiration. Respiration works on a ["CO2"] control system as described previously. (Back to testable material) What is gag reflex? Triggered by touching the ["soft"] palate or ["posterior"] pharynx. Steps of a gag. Deep breath is taken. This raises the hyoid and larynx which opens the esophageal sphincter. Soft palate is elevated which closed the nares. Diaphragm and abdominal muscles contract forcefully. Stomach content expelled. If pt is unconscious or unable to protect airway, pulmonary aspiration may occur. - The smallest opening that an ETT has to pass in an adult is the ["glottis"] . The smallest opening that an ETT has to pass in a pedi is the ["cricoid cartilage"] . - ["simple face mask and partial nonrebreather mask"] 6 to 10 LPM delivers 35 to 60% - ["sniffing"] position also known as inline or neutral head position opens the upper airway. - ["tracheal"] tugging/retraction is seen when their is a partial occlusion of the air passages. =The hallmark sign of dyspnea is an [ ] ["altered mental status"] until proven otherwise. - The PulseOx probe is placed on the ["finger"] , ["earlobe"] or ["toe"] and measures the amount of oxygen bonded to the available hemoglobin. 94% and above is adequate saturations. 90% to 94% may indicate a nasal cannula. Less than 90% usually indicates the need for a non-rebreather mask. - ["finger"] nail polish may interfere with reading and should be removed. ["cold"] body temperature can constrict blood vessels to the probe. Probe elevated or ["lower"] than the heart can affect readings. - If carbon monoxide has saturated the hemoglobin the device will still register 100% saturation. - - As a result of less alveolar tissue the pulmonary capillary beds decrease leading to pulmonary hypertension which results into right sided heart failure which is termed ["Cor Pulmonale"] which means when the patient inhales the BP drops and then they exhale it returns. - Viral and fungal pneumonia present differently; no fever, no cough, no chest pains, just tires with sore throat and n/v. (walking pneumonia) - Spontaneous pneumothorax = 50% of patients will have a re-occurrence within 2 years of the first.

how does body control our respiration

accessory structures that are part of the respiratory system include the inspiratory (relating to the act of breathing in.) and expiratory centers in the medulla and pons =which exert nervous control of breathing. These respiratory centers receive information about the oxygen and carbon dioxide - stretch receptors in the walls of the lungs provide information to the brainstem to prevent accidental over-expansion injuries, and - irritant receptors in the walls of the bronchioles detect the presence of abnormalities such as excessive fluid, toxic fumes or smoke, or significant air temperature changes. - Finally, receptors near the alveoli, called juxta-capillary receptors, detect when the alveolar-capillary beds become abnormally engorged with blood because of heart failure. -

spontaneous pneumothorax

accumulation AIR in the PLERAL SPACE - -1st= MOST common PT = people with lung dzs = dz like pneummnial have long/life lansing effects on lungs = scards - COPD pt their lining GETS thinner and more donidle - 2nd = TALL WHITE SKINNY MALES -lung lining get really thin bc it can't keep up with their Growth = They grow too fast resulting in "thinner" lungs -S/S - first anxiety, then SOB, decreased lung sounds on leaking side, then affected chest rise on affected side. - Usually not life threatening. - COMPLICATIONS -it by itself is not that harmful BUT - that area can get infected and Thats WHEN ITS DEATLY =btw = truama type of thorax is more severe - MIGHT NEED needle decomplestion PLURAL EFFUSION - Collection of fluid outside LUNg / PLEURAL SPACE (dumping too much and not enough taking out) = More fluid in scape = SUDDE N/Unexplained WEIGHT GAIN - - -usually albumen or lymph system gets this fluid = THAT SPACE CAN BE FILLED WITH - air -fluid -Blister - infection

AMI

acute myocardial infarction

Neosporin

antibiotic

5 "Rights"

as the 3 question - can i give this to you - are you allergic - have you had some of the drug recently ? 1) Right patient 2) Right drug ---Right form 3) Right amount 4) Right route 5) Right date - Check for Discoloration or Impurities in meds

RESPIRATORY EMERGENCIES

asthma, chronic bronchitis, emphysema - Ch16 -

Emphysema

aviloly lose ELASTISITY - not a streachy - destuction of aveoli -aS avioly are filled with air - the old air is TRAPPED bc the aviloly needs to streach to force the oxygen out - CÓ build up happens and to keep up out BODY makes more RBC to pic up the Ó that is now has a lesser dergree of exposure - PINK PUFFER + NO productive cough - PInk form the + of rbc - Puffer from thte fact that they have to work hard to keep up= Which makes them SKINNY - non protuvide bc its not a mucus prodution - they caugh bc they are maving out the Ó in traped aveoli HAVE barreled chest - His entercostant are so big that that rhey cnat move anyomore -really harrd whne doing cpr --- this expalins sitting in tripod and sniffing position can get better when stopped smokingn is have 1 they usually have both - emphysema reduction in the alveolar/capillary area in which gas exchange can occur. It is more common in men than in women and is seen most often in people 60 to 70 years of age = -The primary cause of COPD is cigarette smoking. -The second well-recognized cause of emphysema is a genetically triggered decrease in the protein called alpha 1 antitrypsin. = This type of emphysema, also known as genetic emphysema, can occur in people 40 to 50 years of age. =Exhaling becomes an active rather than a passive process, requiring muscular contraction; therefore, the patient uses most of his energy to breathe. = The loss of lung elasticity and trapping of air cause the chest to increase in diameter, =compensates for the disease process by hyperventilating. Because the patient hyperventilates, blood oxygen levels are maintained at a relatively normal level.

Bacterimia

bacteria in the blood

Crackles,= rales

bubbly or crackling sounds heard during inhalation. - associated with fluid that has surrounded or filled the alveoli or small bronchioles - associated with the alveoli and terminal bronchioles "popping" open with each inhalation. - Crackles can indicate pulmonary edema or pneumonia. This type of breath sound typically does not change with coughing or movement. - Crackles (rales) are caused by _____. =air passing through fluid

abnormal breathing

caused by Increased width of the space between the alveoli and blood vessels Lack of perfusion of the pulmonary capillaries from the right ventricle of the heart Filling of the alveoli with fluid, blood, or pus =intubate when "less than 8 = intubate" -Stop Breathing or any one who cannot maintain oxygen levels. Less than 8 or over 30 (with poor patient presentation) ventilations per minute need artificial. = we gonna breath for them by putting mask and expanding thier INHALATION- MAKING THEM FULL/OVERIDE (THIS IS ehy we instuct pt to breath - when they take downers) Override breathing - when patient breathes in provide greater tidal volume. - "if they are not fighting us they need a tube" -= even tho tehy are unconstius - they prob wont let us breath for them, - unless they are uncoustisn = they a need machine bc they are completly rocked = COOL, DAMP (clammy) , pale, blue = not 100% Pursed lips = -kids = holding in breath they are holding in air = peaping -- so that air can gt rhought the block adn gas exchange to happen = employ accessory muscles to help change the size of the thorax (chest cavity)

COPD

chronic obstructive pulmonary disease - Long term problem is hypoxic drive. Start to control breathing with Ó levels not CÓ levels. - 10-30% of pupulation have it now - includes Emphysema , chronic bronchitis , chronic asthma = (mainly EMpha and bron clumped toghetr most of the time) happen due to cosntatn irrantant = polution, smokeing - Diffretn degrees of each dz are present im doffrent diggrest for all pts - NAILS STArt to CLUB = Clubbing = S&S -its flat and it start to burn in the front - people who are rocked use /lung dz guys use cpap = and = (BTW) Patients who suffer from sleep apnea (periods of non-breathing during sleep) can also use CPAP or BiPAP machines - -constantly high carbon dioxide levels in the blood from poor gas exchange cause the respiratory receptors to become insensitive to CÓ and to respond, instead, to low levels of oxygen. Theoretically, if high concentrations of oxygen , the receptors pick up the increased oxygen level in the blood and send signals to the respiratory control center to reduce or even stop breathing. - This usually occurs when high concentrations of oxygen are administered over a long period of time, but it can also occur over a short period of time, especially in the chronic bronchitis patient. =In the prehospital setting, this is a rare event and is not a major concern. Oxygen administration should take precedence over a concern -- (If this should happen, you would initiate positive pressure ventilation with supplemental oxygen, as for any patient with inadequate ventilation.) = literature recommends that the goal is to establish and maintain an SpÓ of 88-92% in patients with known COPD =also shows that patients treated with uncontrolled high concentrations of oxygen had higher mortality rates =As a rule, never withhold oxygen from any patient who requires it.

Rhonchi

coarse crackles, are snoring or rattling noises heard on auscultation. - ["rhonchi"] is a rattling sound in the large airways associated with excessive mucus or other material. - They indicate obstruction of the larger conducting airways of the respiratory tract by thick secretions of mucus. - Rhonchi is fluid in the bronchi. Getting worse. often heard in chronic bronchitis, emphysema, aspiration, and pneumonia -One characteristic of rhonchi is that the quality of sound changes if the person coughs or sometimes even when the person changes position.

hemoptysis

coughing up blood

orthopnea

difficulty breathing when lying down

lungs

for respirations - Separated by the MEDIASTINUM - STERNUM =mediastinum pain Epigastic pain - aroud the xiphoid prosses - BASE of each lungs rest on the diaphragm - APEX/TOPof lungs extend 2.5 cm above each clavicle -

type 1 diabetes mellitus

genetic (-can give to kids ) - no insulin at all - auto- immune dz

Wheezing

high-pitched, musical, whistling sound that is best heard initially on exhalation but can also be heard during inhalation in more severe cases. - indication of swelling and constriction of the inner lining of the lower airways, primarily the bronchioles. -Wheezing that is diffuse (heard over all the lung fields) is a primary indication for the administration of a beta 2 agonist medication by metered-dose inhaler (MDI) or by small-volume nebulizer (SVN). - ) Wheezing is usually heard in asthma, emphysema, and chronic bronchitis.

CAUSES OF DYSPNEA

hyperventilation syndrome - Fast and Shallow -more than 30 or 40 a min =RESULTS IN DECREASE CÓ from breathing it off =WE NEED CÓ/ACID in out body -- LOW CÓ rock our nevers / our nerds dont like it that state - acid/base balance. -Hyperventilation causes an excess loss of CÓ which results in ["hypocarbia"] . = TINGLING in lips , CARPOlPEDAL Spasm = Finger and toe spasm - AWALYS rule out EVERYthing els before saying its HyperVentilation = you can clapped if you miss something - S&S = Anxiety, Dizzyness, carpspas, sense of dyspnea - HOW TO TREAT for this class 1ST - ATTEMT = get them to calm down and emotional supporT - TRY TO GET THEM TO CONTROL/SLOW BREATHING 2ND ATTEMPT =ATTACH SIMPLE FACE MASK = (NON OBRETHER WITHOUT FLAPSOF RESIBOUR) WICH WOULD normally be at 6-10 LMP and RUN AT 2 LPM -CÓ IS BUILDING UP IN TEST = YOU SEE PARTNER DO BAG = TURN IN TO MEDICAL CONTROL Kussmaul = fast and deep =(Note: Fruity Breath)include asthma,=

chronic bronchitis

inflammation of the bronchi persisting over a long time - FILLED WITH EXCESS MUCUS -]=Bronchitis is over stimulated discharge of mucus in bronchus tubes. = muscus = are made to cote/protect lungs from irrantass) = MAKES LUMEN SMALLER - 2 or more years of 2 or more bouts (lasting a few mouths) - they have good and bad mouths - a lot of people have had acute bronc - usually caused by infection that is irrupting the lungs) - THE prob with bronchitis is that we can inhale Ó bc its the active phase of respirations but since exhalation is chill we have a hard time getting rid of the CÓ in the lungs = BUIT UP OF CÓ = tolarant of CÓ - BLUE BLOATER - with productive COUGH - BLUE from cyanosis, - Bloater - Oxygen is a big part of metabolism and slows it down since low Ó & a bulit up of CO@ makes you feels slow and tired -= not moving and = fat - Chronic Bronchitis -affects primarily the bronchi and bronchioles. =involves inflammation, swelling, and thickening of the lining of the bronchi and bronchioles and excessive mucus production. -The alveoli remain unaffected by the disease but affect Ó levels in alveoli =Unlike in emphysema, the pulmonary capillary bed is not damaged. = The chronic hypoxemia causes the heart to work much harder, and heart failure may be seen when the patient develops respiratory distress. - =Recurrent infections leave scar tissue that further narrows the airways. -decrease in oxygen (hypoxemia) and an increase in carbon dioxide (hypercarbia) s&s = Asterixis = residual volume in the lungs that can lead to bloating and a cyanotic appearance.

surfactant

interferes with the hydrogen bonding between water molecules and thereby reduces surface tension in the LUNGS = helps keep separate the water and air -act like chapstick in aveloli smoke inflames the epitlial cells in lungs and it easy for water to move in BABYS born before 34 Weeks are short of SURFACTANT

Second intercostal space

midclavicular line = Sounds heard here represent airflow through the larger conducting airways. Airway structures are still supported by cartilage. Abnormal sounds heard best here include stridor and rhonchi.

["eupnea"]

normal breathing

nare

nostril

what happens is low sugar

pancreas release - Glucagon from Alpha cells - = gets sugar liver from liver and releases sugar

emetic

pertaining to vomiting

pleuritic

pleuritic (pleural space area)

bac pneumonias

pneumonia= inflammation of bronchioles and alveoli from infection = imfal - cause edema - can be treated with rest, and atni-virals or bac - its normally in a singular lobes = but i can spread - =productive cough and may expel yellow to brown sputum. - Lobar Pneumonia = One singular lobe is affected Bronchopneumonia = multiple lobes = In emt exam =" respitory distress with fever is pneumonia unless told other wise " respitory fauily = breathing is so trash that you need a machine to breath for you account for 90% - peack in winter and early spring - nusing home get rocked - mayb be seconday incefetion 0

normal breathing

quiet and effortless, equal chest rise (Breath sounds that are present bilaterally) = IF you are missing ANY OF THESE charaterestinsc - YOU ARE IN SOME form of RESPIRATORY DISTRESS - = DYSPNEA/ dysnic - NOT moving at all === RESPIRATORY arrest - medice is a Seesaw/ - so the body can compensate BUT WE DONT WANT THEM TO be FAST AND DEEP or slow and shallw - we compare breath sounds from the opposite side - THERE SHOULD MOVEMENT OF THE ABDOMENR = preg woman have harder time breathing - normal is defined differently for each individual patient group based on age and preexisting disease - However, a respiratory rate of 24 per minute in an elderly patient is near the average rate. -- = Normal mental status Normal muscle tone Normal pulse oximeter reading (≥94 percent)(≥94 percent) Normal skin condition findings

agonal

respirations near death - neurological breathing

respiratory failure vs respiratory distress

respiratory distress= usually compensation to make up for low Ó =A patient who is has difficulty breathing but has an adequate tidal volume and respiratory rate -compensation is done by the body that ends up Working = Provide supplemental oxygen to maintain and SpÓ >94%. -- The SpÓ of pregnant patients who present in respiratory distress should be maintained at the highest level possible to maintain adequate oxygenation of the fetus -ex= higher RR, use of exesesary muscle , nasal flaring , = Shortness of breath, abnormal upper airway sounds, faster- or slower-than-normal breathing rates, poor chest rise and fall—these and other signs and symptoms of respiratory distress = indicate = hypoxia -shortness of breath occurs when the metabolic demands of the body are not met. = Respiratory Distress causes = hypercarbia (increased carbon dioxide in the blood stream), = cause =with failure of the respiratory system, the neurological system will fail and the patient's mental status will deteriorate =cardiovascular system to fail, causing the patient to display vital sign changes and shock (hypoperfusion) - low Ó = kill or affect cells = For example, hypoxic cardiac cells become irritable and begin to send out abnormal impulses, leading to cardiac dysrhythmias (abnormal heart rhythms). respiratory failure - in the other side of the spectrum ===inadecoqute ó = compensation fails to keep up- - ex/sings = Cyanosis , INCREASE EFFORT for little gain = gasping, hEAD boding , SEE SAW breathing . stridor == CHANGE IN MENTAL STATUS - from CÓ (beme sleepy) == when the tidal volume or respiratory rate is inadequate and no longer can provide an adequate oxygenation of the cells.- or both =If a patient with inadequate breathing is not treated promptly, it is likely that he will deteriorate to respiratory arrest. - Respiratory arrest =No tidal volume and no respiratory rate. The patient may have agonal respirations in which there is a sudden gasping respiration with a long period of apnea. -Immediately begin positive pressure ventilation with a bag-valve-mask device with supplemental oxygen connected to the device. =. Agonal breathing occurs when the brainstem reflex Respiratory distress patients have an adequate chest rise (tidal volume) and an adequate respiratory rate. Because both the tidal volume and respiratory rate are adequate, the patient has adequate breathing and is in need of only supplemental oxygen. -A patient in respiratory failure has inadequate tidal volume or an inadequate respiratory rate (too high or too low) or both. If either tidal volume or respiratory rate is inadequate, the respiratory status is inadequate and the patient needs immediate ventilation. Respiratory failure and respiratory arrest are treated the same way, with positive pressure ventilation and supplemental oxygen. - CPAP is contraindicated in a patient with a suspected pneumothorax

upper and lower infections

there is alot of exprtion in the info virus take over cell - HOST - chronic - not red/sore - is inside so we dont see the effects - watery eyes - clear fleam - life = week FEVER = LOW fever - Foghting a virus weaken our immune system and leadd to for the opurtunity for bacter to take over --colds --CROUP = Laryngitis for adults = is an inflammation of your voice box (larynx) - upper airway closing bacteria - is outside of cell - acute - red/sore - crusty eyes - Sputum - life = Weeks+ = FEVER = 103+ -EPIglottis = lot a official fever till they reach 101 -below = it might be (low grade fevel) Antiboitencs = works by = marking intruder / unacticating toxins (this needs the assistance of a immune system) attacking cell wall of all AID patients - end up dying from pnumonia

type 2 diabetes

these is only a little insulin and cells are resistant to i insulin and tired and trash

emesis

vomiting

btw

you cant leave pt alone to get meds in his house - Drug Detoxification and Removal Drug detoxification primarily takes place in the liver. Think of the liver as a swimming pool filter.

Medications Carried on EMT unit

Ó (and GLUCOSE) - needed for cell production of ATP = (kreb cycle) Activated Charcoal - suspension used to ADsorbant =Charcoal is Carbon is an ADSORBANT Oral Glucose -Gel form glucoe given orally SOME Medical Control let EMT give ASA give

Oxygen

Ó (and GLUCOSE) - needed for cell production of ATP = (kreb cycle) SpÓ over 94% does not need oxygen. Too much oxygen to injured tissues/cells will kill them not help them. -The routine use of oxygen in normoxic (normal oxygen levels--SpÓ 94% or greater) patients is no longer recommended. = so give oxygen if 93 and down or (of pulse oxe not available it seems like they needs Oxygen) - cyanosis ,blood lose, ext Non-Rebreather (NR) @ 15 LPM is 80-95% - BVM room air 21% at 15 LMP = 80-100% - Mouth to Mask air 16% at 15 LPM = 50- 60% Nasal cannula (NC) range 1-6 LPM = 24%-44% - add 4 First 3 are High flow last is low Indication: Dyspnea. Action: increase available Ó. Side Effects: none in emergency. Route: inhalation. Dose: dependent on condition. Contraindicated: none in emergency. - If bag-valve ventilation is being performed on (medical or trauma) , regardless of the conditon or injury, a high concentration of supplemental oxygen must be delivered via a high-flow oxygen source and reservoir connected to the bag-valve device. - However, it is important to emphasize that oxygen is not a harmless drug. In healthy individuals, high concentrations of oxygen have been found to reduce cardiac output and left-ventricular perfusion, which reduces systemic and coronary artery blood flow. In patients with heart disease, hyperoxia (high oxygen levels) leads to coronary artery vasoconstriction and a higher coronary artery resistance, thereby, reducing coronary artery blood flow to the heart muscle. - In some conditions, such as ischemic stroke,, or an acute coronary syndrome involving coronary artery blockage in the heart, administration of oxygen when not indicated may actually worsen the tissue damage (cause reperfusion injury) by an increase in free radical production when the artery is reopened and blood supply reestablished to the once ischemic tissue (reperfusion therapy). - Medical Conditions. In the patient with a medical condition, if the breathing is adequate and the SpÓSpÓ is 94% or greater and no other signs of respiratory distress, hypoxia, hypoxemia, or poor perfusion are present, there is no need to administer supplemental oxygen. - Trauma Conditions. In the patient with a truamatic injury, especially one involving the brain, thoracic organs, or spinal cord; or one in which there is any evidence of respiratory distress, hypoxia, hypoxemia, or poor perfusion; or when the potential exists for significant bleeding or shock, = recommends the delivery of a high concentraton of oxygen to achieve and maintain an SpÓSpÓ of 95% or greater. This is typically achieved through the use of a nonrebreather mask set at 15 lpm