Respiratory Emergencies and other EMT Class Notes

Respiratory Sounds: Snoring

Airway blocked/open patient's airway; prompt transport

Blood Pressure Normal Ranges: Adolescent 11 to 14 years

Systolic: Average 114 (88 to 120) Diastolic: Average 76

Blood Pressure Normal Ranges Preschooler 3 to 5 years

Systolic: Average 99 (78 to 104) Diastolic: Average 65

Blood Pressure Normal Ranges: Adults

Systolic: less than or equal to 120 Diastolic: less than or equal to 80

Presumptive Diagnosis, EMT diagnosis and EMS diagnosis are all...

Terms used to describe the conclusion that an EMT makes about a patients condition after assessing that patient.

Acute Myocardial Infarction (AMI)

The condition in which a part of the myocardium dies as a result of oxygen starvation; often called a heart attack by lay persons. Brought on by the narrowing or occlusion of the coronary artery that supplies the heart.Rarely. the interruption of blood flow to the myocardium may be due to rupturing of a coronary artery (aneurism). Each year their are over a million cases of AMI in the United States, and cardiovascular diease causes hundreds and thousands of deaths annually. A majority of the deaths are (sudden deaths-a cardiac arrest that occurs within 2 hours of the onset of the symptoms.In most cases, sudden death occurs outside the hospital and 25 percent of the patients have no previous history of cardiac problems. A variety of factors can cause AMI. Coronary artery disease is usually the underlying reason for the incident. However for some patients factors as harmless as unusual exertion, severe emotional stress, may trigger an AMI Treatment has changed over the years. Previously patients were admitted to coronary units where they were observed, and when emergencies occurred and treated with varying success. Now some patients receive treatment with medications called fibrinolytics to dissolve the clot that is blocking the coronary artery. To be most effective these medications must be administered early. With each hour that passes before they are administered, they become less likely to dissolve the clott. As noted earlier, an even more effective way to unclog the coronary artery is to insert a catheter with a balloon that can be inflated to reopen circulation to the heart, a procedure known as balloon angioplasty or balloon cathertization. Many patients with myocardial infarction AMI are not candidates for this treatment, but those who are must reach the hospital quickly. A patient that leaves the hospital after an AMI will usually be told to take asprin every day to prevent another episode. The patient will also be told to take a medicine known as a beta blocker. This group of medicines slows the heart and makes it beat less strongly. This would not usually considered a goood thing, but in these patients it results in a decrease in the work the heart has to do. This benefits the heart and leads to longer ad better lives for patients.

Aneurysm

The dilation, or ballooning of a weakened section of the cell wall. When a weakened section of an artery bursts, there can be rapid, life threatening internal bleeding. Tissues beyond the rupture can be damaged because oxygenated blood they need is escaping and not reaching them. If a major artery ruptures, death from shock can occur quickly. The two most common forms of aneuyrsms that you will encounter in an emergency situation are the aorta (Abdominal aortic aneurysm- a ballooning or weakening in the wall of the aorta as it passes through the abdomen,the weakening results in tearing of internal layer of the blood vessel, which allows blood to escape into the weaker outer layers. The effected area can gradually grow and rupture. A sudden rupture of the aorta typically causes sudden onset of excruciating abdominal and back pain. Signs of shock are usually present. Depending on the location of the AAA-Aortic Abdominal aneurism there may be inequality between the femoral or pedal pulses) and the brain. When the brain ruptures a severe stroke occurs.This type of stroke is called a hemmorrhagic stroke, a stroke which is frequently the result of long standing high blood pressure (hypertension- over 120 systolic, over 80 diastolic) and when a a weak area of an artery (an aneurysm) bulges out and eventually ruptures, forcing the brain into a smaller than usual space within the skull.

Bradycardia

When the heart is slow, usually below 60 beats per minute

Generalized Seizures

When we think of generalized seizures, we think of the tonic clonic seizure (a seizure without warning where the patient thrashes wildly)however there are other types of seizures 1)absence seizures(petit mal) brief 1 to 10 second. No dramatic loss of motor function and person does not usually slump or fall. Instead, there is a loss of concentration or awareness. An absence seizure may go unnoticed to anyone but knowledgeable members of family. A young child may suffer several 100 of these seizures every day interfering with his ability to pay attention in school. Absence seizure mostly stop before adult hood.

Sinoatrial node (pacemaker)

Where electrical impulses originate in the heart

verbal report

You will have to give a written report to the hospital personal, but that is time consuming, so your first report will be a verbal report. Transfer your patient to the care of the hospital staff, introduce the patient by name. Then summarize the same kind of information you gave over the radio, pointing out any information that is updated or different from your last radio report. Include the following: 1)Chief Complaint 2)History that was not given previously 3)Additional treatment given enroute 4)Aditional vital signs taken en route

Alergic Reaction

an exagerated immune response. Signs may include:Sneezing, cough, wheezing, possible pallor, little or no flushing of the skin, local swelling, (normal or nearly normal vital signs), mild, moderate or severe anxiety

Side effect

any action of a drug or medication other than the desired action.

Search satisfying

It can be satisfying to finally determine what is causing a patients problem. However, once this happens it becomes easy to stop looking for other causes of potential problems. This is called "search satisfying" The problem with SS is that you can miss a secondary diagnosis. If you don't look for other problems you won't detect them. A good way to prevent this problem is to keep an open mind about other possibilities and to evaluate each diagnosis before accepting it. This principle can best be stated by "Don't count your chickens before they hatch."

When assessing a female patient, which one of the following would be the "most" important to observe about her breathing? A)Presence of breathing and pulse rate B)Breathing pattern and adequacy of breathing C)presence of breathing and adequacy of breathing D)Patient position and adequacy of breathing

It's not enough to simply make sure the patient is breathing. The patient must be breating "adequatly" (C) (p445)

Whrn assessing the neck of an adult female critical trauma patient, the EMT should inspect/palpate for __________in addition to wounds and deformities

Jugular vein swelling

Hallucinogens

LSD, PCP Mushrooms XTC. X, MDMA. Party and rave drugs.

Dyspnea

Labored breathing, shortness of breath, also known as air hunger.

Cyanotic (blue-gray) skin color significance/possible causes

Lack of oxygen in blood cells and tissues resulting from inadequate breathing or heart function

Hypotension

Low blood pressure Lower than 90/60

Low Pressure Flowmeters

Low pressure flow meters, specifically the pressure compensated flowmeter and the constant flow selector valve are in general use in the field.

Rhonchi

Lower pitched sounds that resemble snoring or rattling. They are caused by secretions in larger airways as might be seen with pneumonia or bronchitis or when materials are aspirated (breathed) into the lungs. The difference between cracles and rhonchi is not always obvious and is somewhat subjective. However, rhonchi generally are louder than crackles.

High Pressure Flow Meter

Lower pressure flowmeters administer either 15 to 25 liters per minute. High pressure flow meters can administer more if neccesary. Use thick green hoses. Examples of devices include cpap, bipap and Thumper.

Respiratory Sounds: Strider

(A harsh high pitched sound heard on inspiration) grunting on expiration (especially infants), or gasping often associated with Croup, (Laryngotraceitus) which is described as inflamation of the trachea, (wind pipe) and or Larynx. The strider sound can also be a result inflamation of the epiglotis, (Epiglottitis an infection of the epiglotis that use to effect children till the Haemophilus Influenza Type B (Hib) vaccine. The number of cases have been significantly reduced. It is often caused by a virus or bacterial infection, so as with all vaccines it is not always 100% effective. It is rare, although cases are reported in both adults and children today. Symptoms are generally fever, sore throat, dificulty swallowing.

Type 1 Diabetes

(Formally known as insulin-dependent diabetes) occurs when the pancreatic cells fail to function properly and insulin is not secreted normally. A type 1 diabetic simply does not have enough insulin in his system to transfer circulating glucose into the cells. If left untreated, glucose levels will build up in the blood while the cells of the body starve for sugar--too much glucose in the blood, not enough cells. Typically a type 1 diabetic would be prescribed synthetic insulin to supplement his inadequate naturally occurring insulin.

Type 2 Diabetes

(Formally known as non-insulin dependent diabetes) occurs when the body's cells fail to utilize insulin properly. The pancreas may be secreting enough insulin, but the body is unable to use it to move glucose out of the blood and into the cells. Patients with type 2 diabetes can often control their condition with diet and/or oral antidiabetic medications.

Hyperglycemia

(Hyper means more than normal) High Blood sugar. Hyperglycemia is usually caused by an increase in insulin, which leaves sugar in the bloodstream rather than helping it to enter the cells. The insulin deficiency may be due to the body's inability to produce insulin or may exist because insulin injections were forgotten or not given in sufficient quantity. Infection, stress, or increasing dietary intake can also be a factor in hyperglycemia. Typically hyperglycemia over days and even weeks--contrast to typical rapid onset of hypoglycemia. Glucose levels in the blood creep up while the cells of the body begin to starve for sugar. As blood sugar levels increase the patient may complain of chronic hunger or thirst and hunger. In an attempt to rid the blood of excess sugar, the body will increase urination. Nausea is also a frequent complaint. Extremely high levels of sugar in the blood begin to draw water away from the body's cells potentially resulting in profound dehydration. Starving body cells begin to burn fats and protiens in a manner that results in excessive waste products being released into the system.These waste products build up and combine with dehydration to cause a condition called diabetic ketoacidosis (DKA) Glucose reading of over 140. Prompt transport, no additional Glucose regardless of what book says.

Hypoglycemia

(Hypo means less than normal) Low blood sugar. Caused by any one of the following: 1)Takes too much insulin (or, less commonly, takes too much of an oral medication used to treat diabetes), thereby transferring glucose into the cells too quickly and causing a rapid depletion of available sugar 2)Reduces sugar intake by not eating 3)Overexercises or overexherts himself, thus using sugars faster than normal 4)Vomits a meal, emptying the stomach of sugar as well as other food When blood sugar is reduced, brain cells as well as other cells of the body starve. Even when the cause is too much insulin, the rapid uptake of sugar into the cells soon depletes the available supply to the blood stream. Altered mental status, possibly unconsciousness and even permanent brain damage can occur quickly if the sugar is not replenished. The brain and body do not tolerate low levels of sugar. Because of this fact, hypoglycemia typically has a very rapid onset. Abnormal behavior that mimics a drunken stuper is very common. Other signs of hypoglycemia incude pale sweaty skin;tachycardia and even seizures. Quick replenishment of blood sugar, often in the form of oral glucose, is critical to the patients outcome. When it can be given without threatening the patient's air way, oral glucose should be administered promptly, before patient becomes unconscious Glucose Meter reading between 60-80. Administer glucose and prompt transfer

Inhaled poisons

(Poisons that are breathed in) Can include carbon monoxide (car exhaust, wood burning stoves), chlorine gas (often from swimming pool chemicals), ammonia (often released from household cleaners), sprayed agricultural chemicals and pesticides, and carbon dioxide (from industrial sources)volatile chemicals and industrial solvents (easily changing from liquid to gas)

Partial Seizures

(also called a motor, focal, sensory, or Jacksonian) there is a tingling, stiffening or jerking in just one part of the body. There may also be an aura, which there is a sensation such as smell, bright lights, burst of colors, or a rising sensation in the stomach. It may involve a glassy stare, aimless moving about, lip smacking or chewing, or fidgeting with clothing. The person may appear to be drunk or on drugs. He is not violent but may struggle and fight if restrained.

Radio Report: To avoid miscommunications, use the following guidelines when communicating with medical direction:

*Give the information to medical direction clearly and accuratly. Speak slowly and clearly. The physicians orders will be based on what you report. *After recieving an order for a medication or procedure, repeat the order word for word. You may also ask to do a procedure or give a medication and be denied by medical direction. Repeat this also. *If an order is unclear, ask the physician to repeat it. After you have a clear understanding of the order, repeat it back to the physician. *If an order appears to be inappropriate, question the physician. There may have been a misunderstanding, and your questioning may prevent the inappropriate administration of a medication. If the physician verifies the order, he may explain to you why he has given you that particular order.

Exhalation

Another term for expiration

Inhalation

Another term for inspiration

Medications prescribed to reduce high blood pressure are called...

Anti-hypertensives. See Table 18-1 (p436)

Medications prescribed for heart rhythm disorders are called...

Antiarrhythmics See Table 18-1 (p. 436)

Medications prescribed for the prevention and control of seizures are called...

Anticonvulsants Table 18-1 (p436)

Medications uprescribed to help regulate the emotional activity the patient to minimize the peaks and valleys in her or his psychological and emotional state are called...

Antidepressants See table 18-1 (p.436)

Side effect

Any action of a drug other than the desired action (p.432)

Poison

Any substance that can harm the body, sometimes seriously enough to create a medical emergencey

Respiratory arrest: No breathing

Artificial ventilation: Pocket Mask (PFM), bag-valve mask (BVM), or flow-restricted, oxygen-powered ventilation device (FROPD) Assisted ventilations at 12 minute for an adult or 20/ minute for a child or infant.

The adequate rate of artificial ventilation for a nonbreathing adult patient is_________breaths per minute. A)8 B)12 C)16 D)20

Artiificially ventilate at a rate of 10-12 breaths per minute for an adult and 12-20 breaths per minute for infants and children according to American Heart association standards. (B)(p448)

Danger zone with no apparent hazards

Danger zone to extend at least 50 feet in all directions from wreckage

Cardiac Pace Makers

Defibrillator pads need to be adjusted so they are not directly over the pace maker and to avoid contact with the pace maker

DCAP

Deformity, confusion, abrasion, penetration/punctures

Downers

Depressants such as barbiturates that depress the central nervous system, which are often used to bring a more relaxed state of mind Examples include, sleeping pills or tranquilizers, (roofies) Rohypol (flunitrazepam) Another downer you may see is GHB (gamma-hydroxybutyrate), also known as Georgia Home Boy or goop. In addition to depressing the central nervous system it produces a sense of euphoria and hallucinations. It also causes severe respiratory distress. So severe that patients will require assisted ventilation even though they still may be breathing.

Neutralizing

Despite the sensational portrayal of Brad Pitt and Edward Norton in Fight Club, neutralizing Sodium Hydroxide with vinegar, those substances are almost never around when you need them. Even if they were, they would not be appropriate. Just like pissing on a jelly fish sting, not appropriate. It may cause more harm than good depending on the content of the pissa.

Chronic Obstructive Pulmonary Disease (COPD)

Direct lung and airway damage from repeated infections or inhalation of toxic agents. Bronchitis and emphysema two most common types. Signs/symptoms: Chronic cough, chronic production of sputum. Lung sounds: Rhonchi, wheezes, diminished.

Coronary heart disease CAD

Diseases that effect the arteries of the heart. CAD is often the result of the buildup of fatty deposits on the inner wall of the artieries. This causes a narrowing of the the inner vessel diameter, restricting the flow of blood. Fats and other particles combine to form this deposit, known as plaque. As time passes calcium can be deposited at the site of the plaque, causing the area to harden. This restricts the amount of blood passing through the artery. The rough surface formed inside the artery can facilitate the formation of blood ,clots which narrow the artery even more. The clot and debris from the plaque form a ("Thrombus"- a clot formed of blood and plaque attached to the inner wall of a vein or an artery or vein.) A thrombus can reach a size where it causes and ("Occlusion"-blockage, as of an artery by fatty deposits) which (cuts off) the blood flow, or it may break loose to become an ("Embolism"-blockage of a vessel by a clot or foreign material brought to the site by the blood current) and move to occlude the flow of blood somewhere downstream in a smaller artery. In cases of partial or complete blockage, the tissues beyond the point of blockage will be starved of oxygen and may die. If this blockage involves a large area of the heart (as in a heart attack) or the brain (causing one kind of stroke), results may quickly be fatal. Factors that put a person at risk of developing CAD, such as heredity (close relative who has CAD) and age, can not be changed;however, many risk factors that can be modified. These include hypertension (high blood pressure over 120 systolic, over 80 diastolic), obesity, lack of exercise, elevated blood levels of cholesterol and triglycerides, and cigarette smoking. Damaged caused by the second group can be reversed by quiting smoking, diet and exercise and medication and weight loss for high blood pressure. In a majority of cardiac-related medical emergencies, the reduced blood supply of the myocardium (heart muscle) causes the emergency. Th most common symptoms can range from chest pain to cardiac arrest. Angina pectoris (chest pain), acute myocardial infarction (heart attack), and congestive heart failure are all conditions that can be related to CAD.

Bronchodilater (inhaler)Actions

Beta-adrenergic agonist or beta agonist for short. B distinguishes the family of medication from the group labeled A. Agonist describes medication that stimulates something, in this case, they stimulate muscles to relax Adrenergic refers to adrenaline like properties. Bronchodilators dialate bronchioles, reducing airway resistance

Normal Blood Pressure Rate

Between 120-91Systolic Between 80-61 Diastolic Note: 1)Hypotension (Low blood pressure): occurs at lower than 90/60. This condition can lead to shock. 2)Pre-hypertension: / high blood pressure)120-139 systolic 80-89 Diastolic 3)Stage 1 hypertension: (high blood pressure)140-159 Systolic 90-99 Diastolic 4)Stage 2 Hypertension:(high blood pressure) 160+Systolic 100+Diastolic If a patient is 104/84 they are considered pre-hypertensive. Although their Systolic BP is within normal range their Diastolic BP is too high. Their diastolic BP is the filling of the heart with blood between contractions. This occurs when the ventricles relax. A pre-hypertensive diastolic reading could be indicative of issues with stroke volume on preload. Preload is how much blood is returned to the heart prior to contraction; in other words how much is filled. The greater the filling of heart, the greater the stroke volume.

Overconfidence

Beware of being overly confident. Thinking you know more than you really do can lead to many problems. Be aware of your limitations and be careful in your assesments. Be as objective as possible, keep ego out of this self-evaluation as much as possible. Surveys consistantly show that people think they know more than theyactually do. Gather info in a logical fashion. You can sumnarize this as, "Of course I know what to do, I am an EMT."

Embolism

Blockage of a vessel by a clot or foreign materiel brought to the site by the blood current.

Bronchconstriction

Blockage of the bronchi that leads from the trachea to the lungs

Occlusion

Blockage, as in an artery by fatty deposits

Pulmonary Embolism

Blood clot that breaks off and circulates through venous system. Usually in older patients, but also recent surgery, recent travel, birth control pills. Signs/Symptoms: Dyspnea, acute pleuritic pain, hemoptysis, cyanosis, tachypnea, hypoxia. Lung sounds: diminished in specific area.

You are treating a patient who just came off an airplane arriving from an international destination. A respiratory condition that may cause deep vein thrombosis after sitting for a long flight is called: A)epiglottitis B)Asthma C)acute pulmonary edema D)pulmonary embolism

Blood usually travels thtough the vessels in the lung, eventually getting to the capillaries where oxygen and carbon dioxide are exchanged in the alveoli. When something that is not blood--like a blood clot, air or fat--tries to go through these blood vessels, it gets stuck and blocks the artery in the lungs. This is a dangerous condition known as a pulmonary embolism. The most common form of pulmonary embolism is a blood clot that starts in a vein, often a vein of a leg or pelvis. This dangerous type of clot is called deep vein thrombosis DVT. Three factors increase risk of DVT. 1)limb imobility, 2)local trauma to an extremity or 3)abnormally fast blood clotting. The answer is (D)Pulmonary embolism. Eppiglottitis is a childhood disease with marked inflamation of the epiglotis and not neccesarily circulatory in nature. Asthma typically has episodic excerbations or flares. Once again, symptoms typically don't include DVT. Acute pulmonary edema does effect the oxygen gas exchange via fluid build up in the lungs which can effect the circulatory system; however the onset is slower than that of a pulmonary embolism. Signs and symptoms of pulmonary embolus are extremely variable, so it is a diifficult condition to detect. The typical patient has a sudden onset of sharp, pleuritic pain, dyspenea, anxiety, cough, sometimes bloody sputum, sweaty skin, that is either pale or cyanotic, tachycardia, tachpnea (rapid breathing). Patients also complain about being light headed, with pain and swelling in both legs. (D)pulmonary embolism

Oxygenation of the body's tissue is reduced in a patient with inadequate breathing, so the skin may be_________in color and feel___________.

Blue;clammy and cool

Hyperventilation

Breathing too fast results in decrease in level of CO2. Signs/Symptoms: Anxiety, numbness, sense of dyspnea despite rapid breathing, dizziness, tingling hands and feet, carpopedal spasms.

Medications prescribed to relax smooth muscle of the bronchial tubes are called...

Bronchodilators See table 18-1 (p. 436)

BTLS

Burn, Tenderness, Lacerations, Swelling

Congestive heart Failure CHF

CHF is a condition of excessive fluid buildup in the lungs and/or other organs and body parts because of inadequate pumping of the heart. The fluid build up causes edema, or swelling. The disorder is typically termed congestive because fluid congests, or clogs the organs. It is term heart failure because the congestion both results from and also aggravates failure of the lungs to function properly. Congestive heart failure CHF may be brought on by diseased heart valves, hypertension (BP over 120 systolic and 80 diastolic) or some form of obstructive pulmonary disease such as emphysema. CHF is often a complication of AMI. Congestive heart failure often progresses as follows: 1) Patient sustains and AMI. Myocardium in the area of the left ventricle dies. (Recall function of the heart: The left side of the heart recieves oxygenated blood from the lungs and pulmonary circulation and pumps it to the rest of the body) 2) Because of damage to the left ventricle, blood backs up into the pulmonary circulation and then into the lungs. (Fluid accumulation in the lungs is called Pulmonary Edema). This edema causes poor exchange of oxygen between the lungs and the bloodstream, and the patient experiences shortness of breath or dyspnea. Listening to the patients lungs with a stethescope may reveal crackling or bubbly lung sounds called crackles (rales) Some patients cough up blood-tinged sputum from their lungs. 3)Left heart failure, if untreated, commonly causes right heart failure. The right side of the heart (which receives blood from the body and pumps it to the lungs)becomes congested because clogged lungs cannot recieve more blood. In turn, fluids may accumulate in the dependent (lower)extremities, the liver, and the abdomen. Accumulation of fluid in the feet or ankles is known as (pedal edema). The abdomen becomes noticeably distended. In addition, bedridden pations collect fluid in the sacral areas of the spine. Signs and Symptoms of CHF include: *Tachycardia (rapid pulse, 100 beats a minute or more_ *Dyspnea (shortness of breath) *Normal or elevated blood pressure. (Normal BP-Between 120 and 90 systolic and between 80 and 60 diastolic)(Elevated BP over 120 Systolic, over 80 Diastolic) *Cyanosis (a blue gray color resulting from a lack of oxygen in the body) *Diaphoresis (Profuse sweating), or cool clammy skin *Pulmonary Edema, sometimes coughing up a frothy white or pink sputum *Anxiety or confusion due to hypoxia (inadequate supply of oxygen to the brain and other tissues) caused by poor oxygen/carbon dioxide exchange *Pedal Edema (accumulation of fluid in the feet or ankles) *Engorged, pulsating neck veins (jugular vein distention) *Enlarged liver or spleen with (abdominal distention-a condition of being stretched, inflated or larger than normal)

Congestive Heart Failure

CHF left ventricle--fluid backs up in lungs. CHF right ventricle--fluid backs up in legs.

Skin temperature/condition "Goose pimples" accompanied by shivering, chattering teeth, blue lips, and pale skin

Chills, communicable disease, exposure to cold, pain, or fear

Pleural Effusion

Collection of fluid outside lung caused by irritation, infection, cancer, CHF. Signs/Symptoms: dyspnea. Lung sounds: Diminished or absent in region of fluid.

When assessing the abdomen of an adult male critical trauma patient, the EMT should inspect/palpatate for ___________in addition to wounds and deformities.

Colostomy and/or illiostomy

Rear End Collision

Common cause of head and neck injuries.

Perfusion

Constant supply of oxygen and nutrients to the cells by the flow of blood

Pale skin significance/possible causes

Constricted blood vessels possibly resulting from blood loss, shock, hypertension, emotional distress

Oxygen Delivery Devices: Nasal Canula 1) Flow Rate 2) Oxygen Concentration 3) Appropriate use

1) 1-6 liters per minute 2) 24-44 percent 3) Appropriate for patients who cannot tolerate a mask

Anticonvulsants: Drugs prescribed for prevention and control of seizures

1)Carbamazepine (Epitol, Tegretol) 2)phenytoin (Dilantin) 3)primidone (Mysoline) 4)phenobarbital (Phenobarbital, Phenobarbital Sodium, Solfoton) 5)valproic acid (Depakane) 6)lamotrigine (Lamictal) 7)topiramate (topamax) 8)ethosuximide (Zarontin) 9)gabapentin (Neurontin) 10)levtiracatam (Keppra)

Oxygen Delivery Device: Partial Rebreather Mask 1) Flow Rate 2) Oxygen Concentration 3) Appropriate Use

1) 9-10 liters per minute 2) 40-60 percent 3) Usually not used in EMS. Some patients may use at home to keep CO2(Carbon Dioxide) levels up in their blood to stimulate breathing. Works by providing a means of recycling oxygen and on exhalation preseverving carbon dioxide used to stimulate breathing. not CO (Carbon Monoxide) as the book says on page 229.

CPR

1) Compressions must not be interupted for any longer than 10 seconds.(reassement, pulse checks, placement of airways) 2)compressions should be at least 2 inches deep on adults and at least 1/3 the depth of the chest for infants and children. (about 2 inches for children and 1/2 inch for infants) with full chest recoil. 3)30-2 while air way is set up. rate should be at least 100 per minute. asynchrouness compressions ventilations of 1 second duration to achieve visable chest rise and fall of 8 to 10 per minute every 8 seconds 4)Personel should rotate through the position of compressor to prevent rescuer fatigue

Guidlines for communicating with medical direction

1) Give information clear and acuratly. Speak slowly and clearly. The physicians orders will be based on your report 2)After recieving an order for a medication or procedure, repeat the order word for word. You may also ask to do a procedure or give a medication and be denied that request by medical direction. Repeat this also. 3)If an order is unclear, ask the physician to repeat it. After you have a clear understanding of the order, repeat it nack to the physician 4) If an order appears to be inappropriate, question the physician, There may have been a misunderstanding, and your questioning may prevent the inappropriate administration of medication. If the physician verfies the order, he may explain to you why he has given you that particular order.

The Look Test

1) Patients who appear lifeless 2)Patients who have an obvious altered mental status 3)Patients who appear unusually anxious and those who appear pale and sweaty. 4)Obvious trauma to the head, chest, abdomen, or pelvis 5)Specific positions indicate distress

The components of the focused history and physical exam for trauma patients are as follows

1) Standard Precations 2)Reconsider mechanism of injury (MOI) 3)Continue manual stabilization of the head and neck 4)Consider requesting for ALS personnel 5)Reconsider transport decision 6) Reassess mental status 7)Perform a rapid trauma assesment

Antidepressant agents: Drugs prescribed to help regulate the emotional activity of the patient to minimize the peaks and valleys in their psychological amd emotional state

1) amitriptyline (Elavil) 2)amoxapine 3)bupropion (wellbutrin) 4)clomipramine (Anafranil) 5)venlafaxine (Effexor) 6)escitalopram (Lexapro) 7)fluoxetine (Prozac) 8)impramine (Tofranil, Tripamine) 9)nefazodone (Serzone) 10)nortriptyline (Aventyl, Pamelor) 11)paroxetine (Paxil) 12)protriptyline (vivactil) 13)sertraline (Zoloft) 14)trimipramine (Surmontil) 15)citalopram (Celexa)

Oxygen Delivery Devices: Nonrebreather Mask 1)Flow Rate 2)Oxygen Concentration 3)Appropriate Use

1)12-15 liters per minute 2) 80-90 percent 3)Delivery system of choice for patients with signs of hypoxia, dyspenea, chest pain, suffering severe injuries or displaying altered mental status.

Oxygen Delivery Device: Tracheostomy mask 1) Flow Rate 2)Oxygen Concentration 3)Appropriate Use

1)8-10 liter per minute 2)Can be set up to delivery varying oxygen percentages as required by the patient; desired percentage of oxygen may be recommended by the home care agency 3)A device used to delivery ventilation/oxygen through a stoma or trachestomy tube.

Bronchodilators: Drugs that relax the smooth muscles of the bronchial tubes. These medications provide relief of bronchial asthma and allergies affecting the respiratory system

1)Albuterol (Proventil, Ventolin, Volmax) 2)isoetharine (Bronkometer, Bronkosol) 3)metaproterenol (Alupent, Metaproterenol sulfate, Metaprel) 4)Terbutaline (Brethaire, Brethine, Bricanyl) 5)ipratropium (Atrovent) 6)salmeterol (Serevent) 7)albuterol/ipratropium (Combivent, DuoNeb) 8)montelukast (Singulair) 9)zafirlukast (Accolate) 10)levalbuterol (xopenex)

Pediatric Notes: Since children sometimes can be difficult to assess and communicate with, it is often best to involve the parents of the children when communicating. Two rules of communication are critically important to children.

1)Always come down to the child's level. Never stand above a child, as you will literally tower over the child and appear very intimidating. Crouching down reduces the size difference and greatly improves communication. If the child is not critically ill, you might even take the time to sit on the floor and get slightly below the child in the beginning. 2)Children often sense lies even faster than adults. It is important to tell the truth to children. Remember, you may be the first contact from the EMS system that the child has ever had. Work to make it positive.

Patient assesment using the Cincinnati Prehospital Stroke Scale

1)Ask patient to smile (Demonstrate what you want the patient to do, making sure that you show your teeth. This allows you to test control of facial muscles) 2)Ask patient to close his eyes and extend his arms straight out in front of him for 10 seconds. (normal response is for patient to move both arms at same time) Abnormal is for one arm to drift down or not to move at all 3)Ask person to say something like, "The sky is blue in Cincinnati," An uninjured persons speech is usually clear. A stroke patient will most likely slur speech, use wrong words, or no speech at all. Other signs and symptoms include: 1)Confusion 2)Dizziness 3)Numbness, weakness, or paralysis (usually on one side of the body) 4)Loss of bowel or bladder control 5)Impaired vision 6)High blood pressure 7)Difficult respiration 8)Nausea or vomiting 9)Seizures 10)Unequal Pupils 11)Headache 12)Loss of vision in one eye 13)Unconsciousness (Uncommon)

Six medications you can administer in the field

1)Asprin 2)oral glucose 3)oxygen 4)bronchodilator inhalers 5)nitroglycerin 6)epinephrine auto injectors

5 components of the communication system

1)Base stations 2)Mobile radios 3)Portable radios 4)Repeaters 5)Cell Phones

Theraputic communication Guidlines for dealing with patients, families, friends, and bystander

1)Use eye contact 2)Be aware of your position and body language 3)Use language the patient can understand 4)Be honest 5)Use the patient's proper name 6)Listen

NHTSA Minimum data set Patient Information

1)Chief complaint 2)Level of responsiveness (AVPU)-mental status 3)Systolic blood pressure for patients greater than 3years old. 4)Skin perfusion (capilary refill) for patient less than 6 years old 5)Skin color and temperature 6)Pulse rate 7)Respiratory rate and effort

Anti Dysrhthmics: Drugs prescribed for heart rhythm disorders

1)Digoxin (Lanoxin) 2)propranolol (Inderal) 3)Verpamil (Calan, Calan SR, Isoptin SR, Verelan) 4)procainamide (Procan SR, Promine, Pronestyl) 5)disopyramide (Norpace) 6)carvedilol (Coreg) 7)metoprolol (Lopressor, Toprol XL)

The five rights

1)Do I have the right patient? 2)Is it the right time to administer this medication? 3)Is it the right medication? 4)Is this the right dose? 5)Am I giving this medication by the right route of administration?

FAST(Face-Arm-Speech-Test-Includes components of the Cincinnati Prehospital Stroke Scale)

1)Face-does one side of the patients face droop (ask the patient to smile)? 2)Arms-can the patient hold both arms in front of him? 3)Speech-is the patient's speech clear and understandable? 4)Test-oxygen saturation

Cincinnati Prehospital Stroke Scale

1)Facial Droop Normal:Both sides of face move equally, patient is able to show teeth equally Abnormal:One side of face does not move at all, or no movement at all 2)Arm Drift Normal:Both arms move equally or not at all Abnormal:One sided drifts compared to the other 3) Speech Normal: Patient uses correct words with no slurring Abnormal:Slurred or inappropriate words or mute

6 steps to Primary Assessment

1)Form general impression 2)Assess mental status 3) Assess airway 4) Assess breathing 5) Assess circulation 6) Determine Priority

Bronchodilators (inhalers)Reassesment Strategies

1)Gather vital signs 2)Perform a focused reassesment of the chest and respiratory function 3)Observe for deterioration of the patient; if breathing becomes inadequate, provide artificial resperation.

Herbal agents

1)Ginko biloba: dementia, poor circulation to the legs, ringing of ears 2)St. John's wort: Depression 3)Echinacea: Prevention and treatment of the common cold 4)Garlic: High cholesterol 5)Ginger root: Nausea and vomiting 6)Saw palmetto: Swollen prostate 7)Hawthorn leaf or flower: Heart failure 8)Evening primose oil: Premenstrual syndrome 9)Feverfew leaf: Migraine prevention 10) Kava Kava: Anxiety 11)Valerian root: Insomnia

7 areas to assess during rapid physical examination

1)Head 2)Neck 3)Chest 4)Abdomen 5)Pelvis 6)Extremities 7)Posterior

Narrative sections

1)Include both objective and pertinent subjective information-objective(observable and measurable) subjective (From a patient or individual point of view) 2)Include pertinent negatives-findings that are not tru, but are important to note. Eg. Patient complains of chest pains, but when asked about difficulty breathing claims no difficulty breathing. Another example is a patient with an injured arm, but when asked about pain in arm claims no pain. 3)Avoid radio codes and nonstandard abreviations 4)Write legibly and use correct spelling 5)Use medical terminology correctly 6)If it's not written down, you didn't do it.

Bronchodilators (inhaler) Side effects

1)Increased pulse rate 2)Tremors 3)Nervousness

Thinking like an expert

1)Learn to love ambiguity 2)Understand the limitations of technology and people. 3)Realize that no one strategy works for everyone 4)Form a strong foundation of knowledge 5)Organize data in your head 6)Change the way you think 7)Learn from others 8)Reflect on what you have learned

Routes of administration

1)Oral or swallowed-typically given in pill or capsule (enteral) 2)Sublingual, or disolved under the tongue-Route is through the mouth; however, it is (parenteral) because it is absorbed by the vascular soft tissues of the mouth and not injeted via the GI tract. 3)Inhaled, breathed into lungs, usually as tiny aerosol particles (such as from an inhaler) or gas (such as oxygen). Inhaled medications are breathed through the respiratory system and absorbed into the blood stream through the alveoli. (Parenteral) 4)Intervenous, or injected into a vein-direct access to the bloodstream.(Fastest acting) (Parenteral) 5)Intermuscular, or injected in the muscle-route directly into the muscle. there blood vessels can rapidly absorb medication and transfer it to other parts of the body. Has a much higher route of complication than oral or sublingual routes. Typically uses a needle. When you break integrity of skins defenses infections are somewhat common. (Parenteral) 6)Subcutaneous, or injected under the skin- Similar to intermuscular injections except that they deliver medication into the layers of the skin rather than into the muscle. The result is a slightly slower absorption rate than with intermuscular injection(Parenteral) 7)Intraousseous, or injected into the bone marrow cavity: New technology (the "IO gun" or "IO drill") allows rapid placement of a rigid needle into the bone marrow cavites of long bones such as the tibia. This technology, with compelling research that shows medications and fluids injected into the marrow reach the central circulation as fast as those given IV, has made the IO route popular among ALS providers and emergency physicians in emergency situations such as cardiac arrest. (Best route for pediatrics)(Parenteral) 8)Endotracheal, or sprayed directly into a tube an inserted into the trachea: This route is used in some ALS systems. Endotracheal medications are administered through a tube inserted into the trachea to be absorbed by the tissue of the lungs. Recent evidence has questioned the effectiveness of this route, however, because lung tissue has very unpredictable absorption rates. Yet you may find this route still used as a last resort.(Parenteral)

Routes of administration

1)Oral, or swallowed 2)Sublingual, or dissolved under the tongue 3)Inhaled, or breathed into the lungs, usually as tiny aerosol particles (such as from an inhaler) or as a gas (such as oxygen) 4)Intervenous, or injected into a vein 5)Intramuscular, or injected into a muscle 6)Subcutaneous, or injected under the skin 7)Intraosseous, or injected into the bone marrow cavity 8)Endotracheal, or sprayed directly into a tube inserted into the trachea

Patient information

1)Patient's name, address, and phone number 2)Patient's gender, age, and date of birth 3)patient's weight 4)patient's race and/or ethninticity 5) Billing and insurance information (in many jurisdictions)

Traditional Approach to Diagnosis

1)Patient. Assesment (history, physical exam, vital signs, test) 2)List of possible causes/diagnoses (differential diagnosis) 3)Further evaluation 4)Consider results of evaluation 5)Narrow the list (may have to consider additional possibilities before reaching a diagnosis

Oxygen Delivery Device: Venturi Mask 1)Flow Rate 2)Oxygen Concentration 3)Appropriate Use

1)Varied, depending on device; up to 15 liters per minute 2)24-60 percent 3)A device used to deliver a specific concentration of oxygen. Device delivers 24-60 percent oxygen, depending on adapter tip and oxygen flow rate.

Ingested poison Patient assement

1)What substance was involved 2)When did the exposure occur 3)How much was injested? 4)Over how long a period di the ingestion occur 5)What interventions has the patient, family, or well meaning bystanders taken 6)What is the patients estimated weight? 7)What effects is the patient experiencing from the ingestion?

Look Test

1)Patients who appear lifeless: Who have no movement or apparent evidence or breathing or have only gasping breathing--will be resuscitated by beginning CPR compressions and preparing your diffibrillater as soon as possible if they are found to be pulseless. 2)Patients who have obvious altered mental status: This status can indicated many underlying conditions, from hypoxia to shock to diabetes to overdose to seizure, During the primary assessment, your concern is not the cause of the altered mental status; it is the impact it will have on your patient and your assessment and care decisions. In this case: *Your Primary assessment will be more aggressive because of a higher potential for life threatening problems, including vomitus or secretions in the airway and the need for ventilation. *Your subsequent assessment will likely be done more quickly to expedite transport. 3)Patient who appear unusually anxious and those who appear pale and sweaty: These signs are indicators of possible shock. Recognizing these signs at the earliest possible moment will help you to identify this potentially serious condition early. In this case: *Recognizing anxiety., pallor, and sweatiness early will prompt you to look for other signs of shock as you complete your primary assesment, including observation of rapid pulse and respiratory rates. *Recognizing potential shock early in the call will help you perform appropriate assessments later. In cases of suspected trauma, you will not match this information with the mechanism of injury, the patient's complaint, and assessment findings. In the medical patient, identifying shock may help you identify a body system to examine later (e.g., and symptoms of a heart attack). 4)Obvious Trauma to the head, chest abdomen, or pelvis: Experienced EMT's identify serious trauma to these areas as injuries that can cause airway problems, profound shock, or death. *Head injuries are series because the brain is housed within the skull. Also, because the head bleeds a lot when injured, the airway may require significant attention and care. *The integrity of the chest is vital for breathing. When the chest is injured, normal adequate breathing may be disrupted by rib injury, collapsed lungs, and bleeding from the major blood vessels within the mediastinum. *The abdomen not only contains a rich blood supply, but it also contains many organs that may be injured during trauma. *Injury to the pelvis can cause severe--and even fatal bleeding 5)Specfic positions indicate distress: The tripod position (Figure11-3) indicates significant difficulty breathing, whereas Levines Sign (Figure 11-4) indicates significant chest pain or discomfort. *Seeing either of these signs tell two things. The level of chest discomfort or respiratory distress is severe, and the patient's complaints (cardiac and repiratory) are among the most serious medical complaints, indicating a high priority. These clinical clues aren't all inclusive. Something as simple as the patient saying, that he "isn't himself" may indicate a serious problem.

List 5 high priority conditions

1)Poor general impressions 2)Unresponsive 3)Responsive but not following commands 4)Difficulty breathing 5)Shock 6) Complicated childbirth 7) Chest pain with systolic pressure less than 100 8) Uncontrolled bleeding 9) Severe pain anywhere

EMS Aproach to Diagnosis

1)Primary assesment to find and treat immediate threats life 2)Patient assesment (history, physical exam, vital signs, test) with special attention to looking for red flags 3)Simultaneously, the EMT begins treatment that may be benificial and not harmful, eg., oxygen 4)Consider the most serious condition associated with the patients presentation that can be treated in the field and rule them in or out 5)List of possible causes/diagnoses (differential diagnosis) if time allows 6)Further evaluation in light of limited time available and restricted resources present in the field 7) Consider results of evaluation 8) Narrow the list (may have to re-state the chief complaint as the diagnosis)

Emergency Medicine Approach to Diagnosis

1)Primary assesment to find and treat immediate threats to life 2)Patient assesment (history, physical exam, vital signs, tests) with special attention to looking for red flags 3)Consider the most serious conditions associated with the patient's presentation and rule them in or out (rule out the worst case scenario) 4)List of possible causes/diagnosis (differential diagnosis) 5)Further evaluation in light of time and resources available in the ED 6)Consider results of evaluation 7)Narrow the list (may have to re-state the chief complaint as the diagnosis)

Treatment of anaphalaxis or alergic reaction

1)Primary assessment, care for life threatening problems, breathing and circulation 2)Secondary assessment. Inquire about: *History of allergies *What was the patient exposed to? *How was the patient exposed (contact, ingestion and so on) *What signs and symptoms is the patient having *Progression (What happened first, next? How rapidly) *Interventions (Has any care been provided, Has the patient taken any medicine?) *Interventions (Has any care been provided? Has the patient taken any medication?) 3) Assess baseline vital signs and get remainder of medical history Patient Care: 1)Manage patients airway and breathing. Apply high concentration oxygen through a nonrebreather mask, if you have not already done so during the primary assement. If patient has altered menat status, open and maintain the patient's airway. If the patient is not breathing adequatly provide artificial ventilation 2)You may assist the patient with administration of an epinephrine auto-injector if protocol allows otherwise check with medical direction. Record administration of prescribed injector. Reassess and record findings If patient shows no sign of wheezing or respiratory distress continue assesment

Components of a focused history and physical exam for an unresponsive medical patient include:

1)Rapid physical exam 2)Baseline vital signs 3)Past medical history 4)Intervention and transport

Reassessment

1)Repeat the primary assessment 2)Reassess and record vital signs 3)Repeat pertinent parts of secondary assesment 4)Check interventions

NHTSA Administrative information

1)Time of incident report 2)Time unit notified 3)Time of arrival of patient 4)Time unit left 5)Time of arrival at destination 6)Time of transfer of care

Things that mimic Stroke

1)Tumor or infection in the brain 2)Head injury 3)Seizures 4)Hypoglycemia 5)Bacterial or viral infections that cause paralysis to facial nerves. Treat patient as you would with similar symptoms *For a conscious patient who can maintain his airway, calm him and reassure him; monitor airway; administer oxygen if oxygen saturation is below 94% or if signs of hypoxia or respiratory distress are present *For an unconscious patient who cannot maintain his airway, maintain an open airway; provide high concentration oxygen; transport patient lying on affected side.

Radio Report (Twelve Parts)

1)Unit Identification and level of provider 2)Estimated time of arrival 3) Patients age and sex 4)Chief complaint 5)Brief pertinent history of the present illness 6)Major past illnesses 7)Mental status 8)Baseline vital signs 9)Pertinent findings of the physical exam 10)Emergency medical care given 11)Response to emergency medical care 12)Contact made with medical direction if required or if you have questions

Radio Medical Reports (1-4)

1)Unit Identification and level of provider: memorial hospital, this is community bls ambulance 6 enroute to your location... 2)Estimated time of arrival: ...with a 15 minute ETA 3)Patients age and sex: we are transporting a 68-year-old male patient... 4)Chief Complaint: ...who complains of pain in his abdomen.

Twelve Parts of A Radio Medical Report

1)Unit identification and level of provider 2)Estimated time of arrival (given at the end) 3)Patients age and sex 4)Chief complaint 5)Brief, pertainent history of the present illness 6)Major past illness 7)Mental status 8)Base line vitals 9)Pertinent finding of the physical examination 10)Emergency medical care given 11)Response to emergency medical care 12)Contact made with medical direction if required or if you have questions

Antihypertensives: Drugs prescribed to reduce high blood pressure

1)captpril (Capoten) 2)clonidine (Catapres) 3)guanabenz (Wytensin) 4)hydralazine (Apresoline, Hydralazine HCL) 5)hydrochlorothiazide (Esidrix, Hydrodiuril, oretic) 6)methyldopa (Aldomet) 7)nifedipine (Adalat, Adalat CC, Procardia) 8)Prazosin (Minipress)

Antidiabetic agents: drugs prescribed to diabetic patients to control hyperglycemia (high blood sugar)

1)glipizide (Glucotrol) 2)glyburide (Diabeta, glynase prestab, micronase) 3)insulin (humulin, noolin, NPH, Humalog) 4)metformin (Glucophage) 5)glimepiride (Amaryl) 6)rosiglitazone maleate (Avandia)

Chain of survival

1)immediate recognition and activation 2)early CPR 3)rapid defibrillation 4)effective advanced life support 5)integrated post-cardiac arrest care Statistics: *Typical cardiac patient is male in his 60's, typical witness of cardiac is woman in her 60's *If response time of the the defibrillater (time called recieved to arrival of the defibrillator) is longer than 8 minutes, virtually no patients survive cardiac arrest.

Analgesics: Drugs prescribed for pain

1)proxyphene 2)nalbuphine (Nubain) 3)morphine (Astramorph PF, Duramorph, MS Contin, Roxanol) 4)acetaminopen (Anacin -3, Panadol, Tempra, Tylenol) 5)Ibuprofen (Acitiprofen, advil, Excedrin IS, motrin, Novoprophen, Nuprin 6)Asprin (Ecotrin, Emprin) 7)Codeine 8)Oxycodone (oxycontin) 9)naproxen (Naprosyn) 10)indimethacin (Indocin)

Poison Control number

1-800-222-1222

Signs and symptoms of respiratory distress (14)

1. Dyspnea 2. Altered LOC 3. Anxiety or restlessness 4. Increased/decreased respirations 5. Increased heart rate 6. Irregular breathing 7. Cyanosis 8. Pale conjunctivae 9. Abnormal breath sounds 10. Difficulty speaking 11. Use of accessory muscles 12. Coughing 13. Tripod position 14. Barrel chest

Hypersensativity

Exagerated response by immune system to a substance

Blood pressure ranges

Adult: Systolic-Less than or equal to 120 Distolic-less than or equal to 80

Adequate Breathing Rates

Adult: 12-20 per minute Child 15-30 per minute Infant 25-50 per minute

Acute coronary syndrome (ACS) also called cardiac compromise

A blanket term used to represent any symptoms related to lack of oxygen (ischemia) in the heart muscle. Symptoms and complaints include: chest pain, (dull,heavy or squeezing). Some patients will deny pain, others will describe it as discomfort. Pain, pressure and discomfort commonly radiates to the left arm, down to the upper abdomen, or up to the jaw. Radiation normally to the left arm more, but right arm is also possible. Anothet frequent comlaint and sometimes the only complaint is Dyspnea. If patient complains about dyspnea, ask him about it. ACS patients are often amxious. Some report feeling of impending doom. Irritability and short temper are also reported. Other symptoms include nausea and pain with upper abdomen (epigastric pain) Some patients also vomit. A less comon finding is loss of consciousness. This may be a result of bradycardia or tacycardia which provides an inadequate supply of oxygen to the brain. Other reportrd findings include sudden on set of sweating, abnormal pulse, abnormal blood pressure. Along with brady and tachy, some patients report a fluttering sensation in the chest. Management: Perform primary assesment, perform history SAMPLE and physical exam. Get history of present illness using OPQRST Note any pain or pressure in the abdomen epigastrium, difficulty breathing palpatations, sudden onset, diaphoresis, nausea or vomiting, anxiety, unusual generalized weakness, abnormal pulse (rapid, slow, iregular), abnormal blood pressure. 1)Place patient in fowler or sitting up position (especially true of breathing difficulties) *Patients who are hypotensive (BP lower 90/60) will feel better lying down. This allows blood to flow to the brain. 2) Oxygen should be administered to the patient if they are hypoxic (saturation less than 94%) or those with altered mental status, respiratory distress Consider the following as you decide if O2 therapy is best for your patient. *Patients in repiratory failure, experiencing agnolbreaths and those who apneic will receive ventilation with BVM or pocket face mask. *Patients who have low oxygen saturation or otherwise appear critical (pg 219) should recieve high concentration oxygen with the intent to bring O2 saturation above 94% and relieve discomfort and anxiety. Mask or cannula. *Patients who complain about chest discomfort/pain, are alert, have oxygen saturation of 94% and above should not recieve Oxygen. 3)Transport immediately if patient has any of the folllowing. *No history of cardiac problems *History of cardiac problems, but does not have nitroglercin *Systolic blood pressure below 90 to 100 4)use 12 lead electrocardiogram (ECG). Follow protocol with regard to whether you should transmit it to the hospital or physician for interpretation. Determine if patient has an ST- elevation myocardial infarction (STEMI) may be extremely important in determining the kind of treatment the patient may benifit from and where you will transport the patient. If local protocol suggests percutaneous coronary intervention (PCI) a method to unclog the coronary artery by inserting a catheter with a balloon tip into the arteial system and thread it into the coronary arteries. When the balloon reaches the narrow section of the artery, it is inflated, compressing the obstructive material against the side of the blood vessel and opening up circulation to the heart again, take patient to facility. 5)Give patient Nitro if following conditions are met. *Patient complains of chest pain *Patient has history of cardiac problems *Patients physician has prescribed nitroglycerin (NTG) *Patient has nitro with him *Systolic blood pressure meets your protocol criteria (usually greater than 100 systolic) *Patient has not taken Viagra or similar drug for erectile dysfunction within 48 to 72 hours *Medical direction authorized administration. 6)After 1st dose, repeat if all of the following are met. *Patient experiences no relief or just partial relief *Systolic blood pressure remains greater than 90 to 100 systolic *Medical direction authorizes another dose of medication *Maximum of 3 doses, reassess. Vital signs and chest pain after each dose. If blood pressure falls below 90 to 100 systolic, treat patient for shock (hyperpofusion) 7)Give the patient (or help the patient take asprin if the following conditions are met. *Patient complains of chest pain *Patient is not alergic to aspirin *No history of asthma *Patient not already taking any medication to prevent clotting. *No contraindications to asprin *Patient able to swallow without endangering airway *Medical direction authorizes administration of the medication.

Sudden Death

A cardiac arrest that occurs within 2 hours of the onset of the symptoms. The patient may have no prior symptoms of coronary artery disease. In most cases sudden death occurs outside of hospitals, and the patient has no prior symptoms of coronary artery disease. Nearly 25 percent of these individuals have no previous history of cardiac problems

Thrombus

A clot formed of blood and plaque attatched to the inner wall of an artery

Asystole

A condition in which the heart has ceased generating electrical impulses.

Ventricular Fibrillation

A condition in which the heart's electrical impulses are disorganized preventing the heart muscle from contracting normally

Pulseless electrical activity (PEA)

A condition in which the heart's electrical rythem remains relatively normal, yet the mechanical pumping activity fails to follow the electrical activity, causing cardiac arrest.

Diagnosis

A description or label for a patient's condition that assists a clinician in further evaluation and treatment

EMS diagnosis/EMT diagnosis

A description or label for a patient's condition, based on the patient's history, physical exam, and vital signs, that assists the EMT in further evaluation and treatment; an EMS diagnosis is often less specific than a traditional medical diagnosis

Dysrhthmia

A disturbance in heart rate and rhythm

Crackles or Rales

A fine crackling or bubbling sound heard heard upon inspiration. The sound is caused by fluid in the alveoli or by the opening of closed alveoli.

Glucose

A form of sugar, the body's basic source of energy. The cells require gluclose to remain alive and create energy. We take sugars into our body from the foods we eat, either sugar itself or other carbohydrates that the body's digestive system will convert to gluclose. After the digestive system converts sugar and other carbohydrates into glucose, the glucose is absorbed into the bloodstream. The glucose molecule is large and will not pass into the cell without the assistance of insulin. The pancreas secretes insulin when the blood glucose rises about 90 mg/dl. Insulin binds to the recepter sites on the cells-especially to those in the liver and the muscle-and allows the large glucose molecule to pass into the cells. Patients who are diabetic (1) don't produce insulin (2)don't produce enough insulin, or (3) have a body that has become resistant to the insulin tha is produced. Medications taken by diabetics are designed to overcome these condition

Cystic Fibrosis

A genetic disease that typically appears in childhood, cystic fibrosis (CF) causes thick, sticky mucus that accumulates in the lungs and digestive system. The mucus can cause life threatening lung infections and serious problems with digestion. Signs and symptoms may include: 1)Coughing with large amountd of mucus from the lungs 2)Fatigue 3)Frequent occurences of pneumonia, characterized by fever, more coughing than usual, worse shortness of breath than usual, more sputum than usual, and loss of appetite 4)Abdominal pain and distension 5)Coughing up blood 6)Nausea 7)Weight loss Patients with CF or their parents should be able to tell you how the disease effects the child. Although most patients with this disease are children, many patients are now surviving till adult hood

Subarchnoid Hemmorage

A less common, but important sign of stroke is a headache caused by bleeding from the ruptured vessel If you find a patient cried out in pain, clutched his head, and collapsed. This is important information to relay to the hospital.

Differential diagnosis

A list of potential diagnosis compiled early in the assessment of the patient

AVPU

A memory aid for classifying a patient's level of reponsiveness. The letters stand for: A=alert-awake/oriented (person,place,day) V=verbal-responds to verbal stimuli P=painful-responds to painful stimuli U=unresponsive-no response to stimuli

Detergent Suicides

A method of suicide popular in Japan has started to make inroads in the United States. By mixing two easily obtained chemicals, a person can cause the release of toxic hydrogen sulfide gas. In Japan, the chemicals are frequently toilet cleaner and bath salts, leading to the name "detergent suicide." In the United States other chemicals such as a strong household cleaner, and sulfur, often pesticide, will quickly release significant amounts of toxic hydrogen sulfide gas when mixed together. Hydrogen sulfide is best known for the smell of rotten eggs, but less well known is that even at moderate concentrations, it can be quite dangerous. Hydrogen sulfide not only takes the place of oxygen but also bonds with iron in the cells, preventing oxygen from binding to those cells and getting where it is needed. Mild exposure results in coughing, shortness of breath, headache and vomiting, dizziness. In severe cases fluid will develop in the lungs (pulmonary edema), resulting in death. The typical method includes combining the chemicals in a small enclosed space and posting warning signs advising people not to try to gain access and cause hazardous materials team

Expiration

A passive process in which the intercoastal muscles and diaphragm relax, causing the chest cavity to decrease in size and force air from the lungs

Diabetic Ketoacidosis (DKA)

A person who has diabetic ketoacidosis will commonly have a profoundly altered mental status. He will also have signs and symptoms of shock, caused by dehydration. A waste product of diabetic ketoacidosis is ketones. A person having this complication will breathe rapidly and often emit a fruity, acetone odor on his breath as the body works to breathe off these byproducts.

Toxin

A poisonous substance secreted by bacteria, plants or animals

Pulmonary Embolism

A pulmonary embolism is something other than blood, for example fat, air or a blood clot that tries to go through the blood vessels in the lungs eventually getting to the capillaries where they reach the alveoli where oxygen and carbon dioxode are exchanged. The most common example of this is a blood clot that starts in the vein of a leg or in the pelvis. This type of clot is called DVTor deep vein thrombosis. It can occur in a variety of situations ;however, there are three factors that increase the risk of DVT. First, limb immobility, second, local trauma to an extremity, and third, abnormally fast blood clotting. Patients who are inactive or in the same place for a long priod of time (IT workers and transcontinental travelers);patients with cancer, women on birth control and patients with lower extremity injuries (such as casted fractures) are at an increased risk of developing DVT. Other things can block the pulmonary arteries, througj not as often as a blood clot. A significant amount of air introduced into a vein can cause great harm and even death. If fat gets in the circulation--for example from the marrow of a fractured bone--the same results can occur. The signs and symptoms vary making it difficult to detect. The typical symptoms include sudden onset of sharp plueritic chest pain;dyspenea, anxiety, a cough (sometimes bloody sputum), dyophoresis, pale or cyanotic, tachycardia and tachypnea(rapid or elevated breathing). The reality is few patients present themselves this way. Many patients complain of dizzyness and feelings of lightheadedness with pain inswelling in one or more legs. Wheezing is sometimes heard though chest auscultation. If there is a large clot, the patient may be hypotensive or go into cardiac arrest. Treatment protocal incudes calls for the EMT to administer oxygen as he or she would do with any patient exhibiting dyspnea. Be concious of patients with a previous history of DVT. Pulmonary embolism can be prevented by avoiding long periods of inactivity and staying active.

seizures

A seizure is a when the brains electrical system becomes irregular. This sudden irregularity can bring about a sudden change in sensation, behavior or movement. Beecause they only affect one side of the brain patient may not lose consciousness 2 types of seizures 1) Partial seizures: seizures that affect only one side of the brain and or body. 2)Generalized seizures: affect the entire brain as a result affect consciousness of the patient. EMS is mostly called about Tonic-clonic seizures: Seizures in which the patient will thrash around wildly, using hiis entire body. The convulsions last a few minute and has three distinct phases. 1)Tonic Phases: The body becomes rigid, stiffening for no more than 30 seconds. Breathing may stop, the patient may bite his tongue (rare), and bowel and bladder control could be lost. 2)Clonic Phase: The body jerks about violently, usually for no more than 1 or 2 minutes (some can last 5 minutes) The patient may foam at the mouth and drool. His face and lips become cynotic. 3)Postical Phase: The postical phase begins when convulsions stop. The patients may regain consciousness immediately and enter a state of drowsiness and confusion, or he may remain unconscious for several hours. Headache is common The length of the postical phase vary greatly. Some patients come around quickly others take longer. It's important to understand that patients become combative and even violent toward rescuers during this phase. Safety is priority #1

Anaphalaxis

A severe or life threatening allergic reaction in which the blood vessels dilate, causing a drop in blood pressure, and the tissues lining the respiratory system swell, interfereing with airway, also called anaphylactic shock, Moderate to severe dyspnea, tightness of the chest. wheezing, muffled voice, stridor, generalized hives, generalized pallor or flushed skin,pale cool, clammy swelling of the face, lips, tongue, mouth, injection site, tachycardia, decreased oxygen saturation, feeling of impending doom, altered mental status

Red Flag

A sign or symptom that suggests the possibility of a particular problem that is very serious

Ischemic stroke

A stroke that occurs when a clot or embolism occludes (blocks or cuts off) an artery

The areas assessed and what you are looking for in rapid trauma assesment include

A) Head-wounds, deformities, tenderness, plus crepitation B)Neck-wounds, deformities, tenderness, plus JVD and crepitation (then apply cervical collar) C)Chest-wounds, deformities, tenderness, plus, crepitation, paradoxical motion, and breath sounds (absent, present, equal) D)Abdomen-wounds, deformities, tenderness, plus firm, soft, and distended E)Pelvis-wounds ,deformities, tenderness with gentle compressions for tenderness of motion F)Extremities-wounds, deformities, tenderness, plus distal circulation, and sensory and motor function G)Posterior-wounds, deformities, tenderness (To examine posterior, roll patient using spinal precautions)

Significant Mechanisms of Injury

A) Unresponsive or altered mental state B)Airway that is not patent C)Respiratory compromise D)Pallor, tachcardia, and other signs of shock E)Penetrating wound of the head, neck, chest, or abdomen (e.g., stab and gunshot wound)

To determine signs of adequate breathing, the EMT should

A) look for adequate and equal expansion of both sides of the chest when the patient inhales B) listen for air entering and leaving the nose, mouth and chest C) feel for air moving out of the nose or mouth D) check for typical skin coloration. E) note the rate, rhythm, quality, and depth of breathing typical for a person at rest

List the six steps involved in repeating the primary assessment

A)Reassess mental status B)Maintain open airway C)Monitor breathing for rate quality D)Reassess the pulse for rate and quality E)Monitor skin color and temperature F)Reestablish patient priorities

Jaundiced (yellow) skin color significance/possible causes

Abnormalities of the liver

Spontaneous Pneumothorax

Accumulation of air in pleural space caused by trauma or some medical conditions. Signs and symptoms: Dyspnea and sharp pain on one side. Lung sounds: absent or decreased in specific area.

Inspiration is a _________process in which the ____________muscles and the diaphram__________and ____________ the size of the chest cavity and causes air to flow _________the lungs

Active process, intercoastal muscles, diaphram contract and expand, causes air to flow into the lungs

Asthma

Acute spasm of bronchioles and excessive mucus production. Lung sounds: wheezing heard everywhere.

Normal breathing: Characteristics of adequate breathing

Adequate breathing falls within certain ranges that are considered normal. Full sentences without having to catch breath. Patient will not appear in distress. 1) Normal rate- rates vary by age. Adult 12-20,child 15-30, infant 25-50 breaths per minute. 2)Rhythm- regular, breaths taken at regular intervals lasting for about the same time. Talking and other factors can make breathing irregular 3)Quality-Breath sounds when ausculated with a stethescope, lung sounds will normally be present and equal when compared. Chest cavity should move equally and adequatly to indicate proper air exchange. Depth of respiration should be adequate. Unlabored. Using look listen and feel method EMT should feel airflow from the patients mouth and nose. No obvious deformities of chest or paradoxal movement noted. Change in the diameter of the chest cavity even slightly can cause airway resistance impacting airflow. Clear lung sounds on auscultation, free of gurgling, gasping, wheezing, crowing, snoring, strider. Adequate tidal volume 5-7 ml per kg of body weight. Normal aveolar ventilation and gas exchange. Normal minute volume. Alert, calm, pink skin. There should be no blue or gray colorations (cyanosis) indicating hypoxia . EMT may administer o2 to patient with normal breathing due to a medical or traumatic condition via nasal cannula.

Acute pulmonary edema treatment

Administer 100% O2. Suction secretions. Transport in position of comfort.

Spontaneous pneumothorax treatment

Administer O2. Transport in position of comfort. Monitor closely

Upper/Lower airway infection treatment

Administer warm, humidified oxygen. No suction/OPA if epiglotitis suspected. Transport in position of comfort.

Asthma: Small airways become reactive and constrict. Air does not move in and out easily although exhaling is more difficult. This results in air trapping. Upon auscultation of a full respiratory cycle, you will notice that the expiratory phase is prolonged. "Triggers" such as exercise, alergens, respiratory viruses, and even aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) cause this reaction.

Albuterol is a medication very commonly used during asthma attacks. It is available in an inhaler and in a small volume nebulizer (SVN) Albuterol must actually enter the smaller airways it acts upon contact. Albuteral acts on (beta2) receptors, which results in dilation of the airway The fact that albuteral acts primarily on the specific receptors means there will be limited cardiac side effects (such as rapid heart rate)

Delrium Tremors (DT's)

Alcohol withdrawal when someone quits suddenly, characterized by sweating, trembling, anxiety, and hallucinations. Signs include: Confusion, unusual behavior, to the point of demonstrating insane behavior, hallucinations, Gross Tremor (Obvious shaking) of the hands, profuse sweating, seizures, hypertension BP over 120 systolic over 80 diastolic

Anaphylatic Reactions

Allergen can trigger asthma attack. Signs/symptoms: airway swelling, dilation of blood vessels (lowered BP), widespread itching. Lung sounds: wheezing, stridor (late-stage).

Cardiac Output

Amount of blood ejected from the heart in 1 minute HR+SV

Stroke Volume:

Amount of blood ejected from the heart in one contraction

Maintaining an IV

An IV must continue to flow at the proper rate once it has been inserted into the patient's vein. However, a number of things may interupt the flow. If you are charged with maintaining an IV, be sure to check for and correct the following problems: A)The constricting band used to raise the vein for insertion of the needle may have been mistakenly left on the patient's arm, perhaps covered by a sleeve. B)The flow regulator may be closed C)The clamp may be closed on the tubing D)The tubing may kink E)The tubing may get caught under the patient or the backboard. The position of the IV or the patient's arm also may need to be adjusyed. Some IVs only flow when the patient's arm or IV site is in a certain position. Adjusting, or even splinting, the arm may be helpful as long as the splint is not to tight. Since the IV flow usually depends on gravity, be sure that the the bag is held well above the IV site and the patients heart. Insufficient blood flow can clot the catheter which can be prevented by adjusting tbe flow to an adequate "keep the vein open" or KVO rate, Although the KVO rate varies, it is usually about 30 minute for a micro drip and 10 drops per minute for a macro drip set. If the drip chamber is overfilled, clamp the tubing invert the drip chamber, and pump some fluid back into the nag. If an IV rate is too fast it is called a "runaway IV." It can rapidly overload the patient with fluid and cause serious problems, especially to an infant or child. An infiltrated needle is one where the needle has either puntured the vein and excited the other side or has pulled out of the vein. In either case, the fluid is flowing into surrounding tissues instead of into the vein. An unnoticed infiltrated IV can be very dangerous. Certain high-concentration medication (such as 50 percent dextrose) can cause the death of surrounding tissue. In addition to comlaining of pain, the patient will show swell i ng at the site (noticeable in all but some obese patients) The person in charge of maintaining th IV.

Inspiration

An active process in which the intercoastal muscles and the diaphram contract, expanding the size of the chest cavity and causing air to flow into the lungs

Critical thinking

An analytical process that can help someone think through a problem in an organized and efficient manner

Untoward effects

An effect of a medication in addition to its desired effect that may be potentially harmful to the patient (p.432)

Hypercapnia

An excess of carbon dioxide in the blood

Ischemia

An inadequate blood supply to an organ or part of the body, esp. the heart muscles.

Medications used for pain relief are called...

Analgesics. See Table 18-1 (p436)

COPD treatment

Assist with prescribed inhaler. Transport promptly in position of comfort.

Severe Respiratory Distress: A)Speaking only 1-2 word sentences; Very diaphoretic (sweaty); Severe anxiety. B) If patient condition continues to deterieriate: Sleepy with head-bobbing; Becomes unarousable

Assisted ventilations: A)Pocket face mask (PFM), bag-mask (BVM), or flow-restricted, oxygen-powered ventilation device (FROPVD) B) Assist the patient's own ventillations, adjusting the rate for rapid or slow breathing

Asthma

Asthma is a chronic disease that has episodic exacberations or flares(A disease that only effects the patient in intervals). This is far different from chronic bronchitis or emphysema, which both continually effect the patient and produce a hypoxic drive. Between episodes, asthmatics can live normal lives. Many patients use steroid inhalers with albuteral administered for a "rescue" during a flare. Attacks can be precipitated by insect stings, air pollutents, stress, infection and strenuous exercise. When an attack occurs, small bronchioles that lead to air sacs in the lungs become narrowed because of the contraction of muscles that make up the airway. To complicate matters, the combination of contractions and an over production of mucas cause the air passages to practically close down severly restricting air flow. The air flow is mainly restricted to one direction. When the patient inhales, the expanding lungs exhert and and pull outward, increasing the diameter of the airway and allowing air to flow in the lungs. During exhalation, however, the opposite occurs and the stale air becomes trapped in the lungs. This requires the patient to exhale the air forcefully, producing the characteristic wheezing sounds associated with asthma.

Your patient has chronic respiratory disease that has episodic exacberations or flares. He is most likely suffering from: A)pulmonary edema B)Asthma C)pneumonia D)emphysema

Asthma is a chronic respiratory disease that has episodic exacberations (B)(p457)

Low Blood Pressure

Athlete or other person with normally low blood pressure; blood loss; late sign of shock

Aura

Aura is also the sensation the patient gets when the seizure is about to happen

7 vitals to check

BP, RR, Pulse, Pulse ox, Blood Sugar, Skin Condition, Pupils,

Mechanical Airway Obstruction

Be prepared to treat quickly. My result from position of head, tongue, foreign body, vomit. Opening airway may solve problem.

Pulse Quality: No pulse

Cardiac arrest (clinical death)

Syrup of Ipecac

Causes vomiting in most people with just one dose. When vomiting occurs, it results, on the average in removal of less than one third of stomach contents. Because Ipecac is slow, is relativly ineffective, and has the potential to make a patient aspirate vomitus, it is rarely used today.

Chemoreceptors

Chemical sensors in the brain and blood vessels that identify changing levels of oxygen and carbon dioxide

Volatile Chemicals

Chemicals that produce vapors that are inhaled. Cleaning fluid, glue, model cement, solutions used to correct typing mistakes are commonly abused

Cpap

Continuous Positive Airway Pressure: 1 pressure and flow. Consists of a mask and a means of blowing oxygen and air into the mask at relatively low pressures. Patients with obstructive sleep apnea sometimes have these devices at home and use them at night to keep their airway from collapsing during sleep. It works by blowing positive low pressure continuously into the airway preventing the alveolu from collapsing at the end of exhalation and it pushes fluid out of the alveoli back into the capillaries that suround them. Portable CPAPs are realitivly new. Common uses include pulmonary drowning and edema, in which there is fluid in the alveoli that can be pushed out of the alveoli and back in the capillaries;asthma and COPD, in which the alveoli are at risk of closing at the end of each exhalation; and in some EMS systems respiratory failure in general. Containdications generally fall into two classes;anatomic-physiologic and pathologic. Anatomic- physiologic contraindictions include mental status so depressed that the patient cannot protect his airway or follow instructions ;lack of normal, spontaneous respiratory rate (CPAP increases the volume of air the patient breathes, but does not increase the patient's respiratory rate);inability to sit up;hypotension (BP lower than 90/60);and the inability to get and maintain a good seal. Pathologic contraindications include nausea and vomiting; penetrating chest trauma particularly when Pnuemothorax is possible;shock;upper gastrointestinal bleeding or recent gastric surgery;and other conditiond that would prevent a good mask seal, as congenital facial malformations, trauma, or burns. There are other conditions in which, even though CPAP may not be contraindicated the EMT needs to exercise caution,eg claustrophobic patients, history of inability to use CPAP, secreations so copious they need to be suctioned, and patients with a history of cystic fibrosis. Since CPAP works by maintaing positive pressure throughout the respiratory cycle, less blood is able to return to the heart, so cardiac output decreases, frequently resulting in a drop in blood pressure. This may cause patients to become hypotensive, for this reason a patient needs to have a systolic blood pressure of at least 90 mmHg When lungs are subject to continuous posditive pressure, there is also a risk that the pressure may causr a weak area to rupture, leading to pnuemothorax. This rosk is increased in patients with COPD and asthma, however COPD patients with breathing difficulties are typically treated with BiPAP Patients who are vomiting (or nauseated, putting them at risk of vomiting) have an increased risk of aspiration (air being pushed into the stomach) positive pressure can push air into the stomach, resulting in gastric distention (bloating because of air and nausea.This can lead to vomiting and blowing of vomitus into the airway and lungs. A less dangerous side effect, is dying of the corneas of the eyes caused by small leaks in the mask. Different models are available. Battery powered with adjustable pressure. The advantage is being able to use only as much oxygen as needed, the disadvantage is it needs to be charged up. Another model has no machine, but instead uses a venturi principle.As oxygen goes through specially shaped channels in the mask, certainflow rates create pressure. Higher flow rates, create higher pressure. Advantage lighter weight and no need for battery/disadvantages uses 02 quickly. To apply CPAP, explain ro patient what you are doing and that it may feel strange as the mask will push air into the lungs. If patient has never used CPAP, have the patient hold the mask initially , once he gets used to it and feels improvement you can attatch straps. Start with low level. Many systems start between 2 and 5 centimeters of water (cm H2O). Reasses patiens signs and level of dyspnea. Raise level if no relief within a few minutes. If patients mental status deteriorates or their respiratory condition worsens, remove CPAP and begin ventilating the patient with a bag mask Follow protocol, on how much you start with and frequency of increase.

The use of CPAP may be indicated if the patient who you suspect has ____________also has stable vital signs. A)a viral repiratory infection B)epiglottitis C)Acute Pulmonary Edema D)spontaneous pneumothorax

Cpap can be very helpful with the patient who is alert and complaining of the signs and symptoms of acute pulmonary edema. Patients with congestive heart failure (CHF) may experience difficulty breathing because of fluid that accumulates in the lungs, preventing adequate breathing. The abnormal level of fluid in the alveoli of the lungs is known as pulmonary edema. It typically occurs because the left side of the heart has been damaged by myocardial infarction (heart attack) or chronic hyperyension. Since the left side of the heart recieves blood from the lungs, the inability to pump blood out results in pressure building up and going back into the lungs. Since there is only one layet of cells lining the alveolus and one layer of cells covering the adjoining capilarries, when pressure builds up, it is relativly easy for fluid to cross the thin barrier and accumulate in the alveoli. If fluid occupies the lower airways, it is difficult for oxygen to reach the blood and the patient experiences dyspnea. Treatment includes high-concentration oxygen mask unless patient's breathing is inadequate and you need to ventilate the patient. If at all possible, keep the patients legs in a dependent position (Hanging down). Bringing legs up may push fluid into the already overloaded circulatory system and make matters worse. Cpap may be very useful in these patients since it can physically push the fluid back out of the lungs and ito the capillaries where it belongs. In patients with spontaneous pnuemothorax oxygen administration is protocol ;however,CPAP is contraindicated. Most patients with spontaneous pnuemothorax will need a small catheter or larger plastic chest tube inserted between the ribs, then into the pleural space around the collapsed lung. The catheter will help help remove air, allowing the lung to re-expand. Epiglottitis is an inflamation of the epiglotis often seen in children. Since th Hib Vaccine it is not as prevelent today as it was years past. Symptoms are similar to coup eg. Bronchial breathsounds, strider, diffficulty swallowing. Management includes tracheal intubation and oxygen administration Viral respiratory problems typically managed with oxygen administration. Because it's viral and not bacterial antibiotics often harm by promoting antiobiotic resistance. Your answer is(C)

When assessing the head of an adult male critical trauma patient, the EMT should inspect/palpate for ____________in addition to wounds and deformities

Crepitation

Cylinder constants

D = 0.16 E = 0.28 M = 1.58 G = 2.41 H = 3.14 K = 3.14

Patient refusal

Document all actions taken to persuade the patient to go to the hospital. Additionally, make notes on patient compentency, or her ability to make an informed rational decision on her medical condition. If the patient is not capable of making this determination for any reason, including age, intoxication (alcohol and/ot other drugs), mental competency, or as a result of patients medical condition, you must document it. If patient does refuse care and transport, have her sign a refusal of care form. Also include information about refusal in the narrative section of the prehospital report. Be sure to convey an alternate care suggestion such as encouraging him to seek care from a doctor, and document it. Try to be sure a responsible family member or friend remains with the patient. Make sure that the patient understands they should seek care.

Corection of errors

Draw a single line through the error, initial it, than right the correct information beside it. If an error is discovered at a later date, after a report has been submited, draw a single line through the error, mark with initials, date, and add correct information. If copies of the report have akready been sent to other agencies, a corrected copy may need to be sent to those agencies as well. On electronic systems, log in and make the correction. Follow agency procedures for correction of errors

Narcotics

Drugs capable of producing stupor or sleep. Often used to relieve pain Example include, Codeine, Heroin, Oxycodone. Narcotic overdoses are characterized by coma (or depressed level of consciousness), pinpoint pupils, and repiratory depression (slow, shallow repiration) Together they are refered to as the opiate triad

Anchoring and adjustment

EMT considers a particular condition to be likely, and his later thinking is anchored to that hypothesis. He may adjust it in time, but sometimes not as much as he should because thats his starting point. For example, an EMT may initially think that an unconscious intoxicated person is unconscious because he is intoxicated. When information appears he may have sustained head trauma, the EMT may cling to the hypothisid that the patients real problem is just intoxication. To avoid this becareful not to jump to any conclusions and determine a diagnosis on the basis of just a few signs or symptoms. Do a thorough assessment. The tendency to cling to your first conclusion is exemplified in the saying,"You only get one chance to make a first impression."

Data elements

Each individual box in the prehospital care report is called a data element. Although, some elements may seem insignificant, each is actually an importany part of the report and the description of the patient and response. These elements are neccesary for research and documenting a call. To aide in research accross states and regions, the National Highway Traffic Safety Administration (NHTSA) has developed a data set of over 400 elements. There is a standardized definition of of what each element means so that regions and states can consolidate and compare data. There is a smaller subset of data that contain elements that prehospital care reports should have nationwide. Formats vary paper to electronic and may include check boxes, short answers, narative sections for longer answers

Chronic Obstructive Pulmonary Disease (COPD)

Emphysema as well as chronic bronchitis, black lung, and many undetermained respiratory illnesses thay cause the patient problems like those seen in emphysema--are all classified as chronic obstructive pulmonary disease (COPD) COPD is mainly a problem of middle-aged or older patients. This is because these disorders take time to develop as tissues in the respiratory tract teact to irritants. Cigarette smoking causes the ovetwhelming majority of cases of COPD. Occasionally other irritants such as chemical, air pollutants, or repeated infections cause this condition. In chronic bronchitis, the bronchiole lining is inflamed and excess mucas is formed. The cells in the bronchioles that normally clear away accumulations of mucas are not able to do so. The sweeping apparatus on these cells, the cilia, have been damaged or destroyed. In emphysema, the walls of the alveoli break down, greatly reducing the effectiveness of normal breathing efforts. The lungs begin to lose elasticity. Many COPD patients will exhibit characteristics of both emphysema and chronic bronchitis. Usually the reason a COPD patient calls the ambulance is that a recent upper respiratory infection has caused an acute worsening of his chronic disease. This may cause the patient to experience a fever and cough up green and dark sputum. A very few COPD patients develop a hypoxic drive to trigger respirations. In patients without COPD, the brain determines when to breathe based on increased levels of catbon dioxide in the blood. Since COPD patients develop a tolerance to their body's high levels of carbon doxide, the brain learns to rely instead on low oxygen levels as a trigger to breath. The higher oxygen levels that result from oxygen administration may, in rare cases, signal the COPD patient to reduce breathing or even to stop breathing (develop respiratory arrest). In most cases, however, the hypoxic drive will not be a problem in the prehospital setting. (Indeed, many patients with COPD are on continuous home oxygen by nasel cannula because of chronoc hypoxic hypoxia.) The patient has a possible heart attack or stroke, is developing shock, or has respiratory distress, a higher concentration of oxygen will be required in spite of the potential problems. If oxygen is required by a COPD patient, do not withhold it. Constantly monitor the patient. If the patient's breathing becomes inadequate or stops, be prepared to assist repirations through artificial ventilation, and then contact medical direction.

Flushed (red)skin color significance/possible causes

Exposure to heat, emotional excitement

Smoke inhalation

Eye irritant, skin irritant, injury to airway, cause of respiratory, and in some cases cardiac arrest Signs that an EMT will see *Difficulty Breathing *Coughing *Breath that has a "smoky" smell or the odor of chemicals involved at the scene *Black (carbon)residue in the patient's mouth and nose *Black residue in any sputum coughed up by the patients *Nose hairs singed from superheated air

Falsification

False entries or misrepresentations on a report are usually intended to cover up serious flaws in assesment and care. Two types of errors: 1)Omissions- those in which an important part of the assesment process was overlooked. If a patient is experiencing chest pain, oxygen was appropriate. If it was overlooked, never write down that it was given when it was not 2)commision-actions preformed on the patient that were wrong or improper. Eg. Incorrect administration of medication. If medication was administeted when it was not indicated, it is important to twll medical direction as this could cause further problems for the patient and for you because of the commision.

Normal Pulse Rate (Beats per minute at rest)

Find radial, carotid, brachial or other artery, feel for pulse for 30 seconds and multiply by 2. Adults: 60 to 100 Adolecents11 to 14: 60 to 105 School age 6 to 10: 70 to 105 Preschooler 3 to 5 years: 80 to 120 Toddler 1 to 3 years: 80 to 140 Infants 0 to 5 months: 90 to 140 Newborn: 120 to 160

Acute Pulmonary Edema

Fluid build-up in lungs. Signs/Symptoms: Dyspnea, frothy pink sputum. Hx of CHF common. High recurrence. Lung sounds: Fluid at base of lungs.

Respiratory Sounds:Gurgling

Fluids in airway/suction airway; prompt transport

Physical exam: quick assesment of affected body parts

Focus on areas of complaint first, next vital signs, next check head, neck, chest, abdomon, pelvis, extremities posterior for secondary injuries.

Information gathered during a call

Following run data and basic patient info, prehospital care reports provide information about the entire call. This info may include... 1)Your general impression of the patient 2)A narrative summary of events throughout the call, including the chief complaint, history of the present illness, past medical history, physical exam, and care 3)Specific sections to detail prior aid, past medical history, physical exam, vital signs, ECG results, procedures and treatments, medications, administered, and other information about the call as required by your service 4)Transport information

Fio2

Fraction of inspired air we breath

Danger Zone with hazards

Fuel spill: 100 feet also park upwind Vehicle on fire: 100 feet Hazardous materials: Size of danger zone dictated by nature of material. Read placard on back of truck with binoculars, seek advice from CHEMTREC, consult Emergency Response Guidebook (ERG) Down Wires: extend beyond intact pole for full span and to the sides for the distance the severed wires can reach.

The approach that clinicians use to arrive at a diagnosis includes includes...

Gathering information, considering possibilities, and reaching a conclusion. (That is a generalization based on I imagine a Doctor in a third world country that only has bandaids.) Learn it this way for testing purposes. In real life, lab tests, mris, ct scans are part of process of making a difinitive diagnosis for an illness or injury. The book and the workbook contradict themselves (pp 384, 385) WB page 149, question 3 of chapter 16.

Bronchodilators (inhalers)Medication Names

Generic:albuterol, isotharine, metaproterenol Trade: Proventil, Ventolin, Bronkosol, Bronkometer, alupent, metaprel

Oxygen Cylinders: duration of flow formula

Guage pressure in psi (pohunds per square inch) minus the safe residential pressure (always 200 psi) times the contant. Next divide by the flow rate. Example: An M cylinder that has a pressure of 2,000 psi on the pressure gauge and a flow rate of 10 liters per minute. (2000-200) × 1.56 = 2808. 2808 ÷ 10 = 280.8 minutes.

Constant Flow Selector Valve

Has no guage, allows for incrimental flow adjustment ( eg. 1, 2, 3, ...15 liters per minute). Used with nasal canula or nonrebreather and with any size oxygen tank.

Pulse Quality: Slow

Head injury, drugs, some poisons, some heart problems, lack of oxygen in children

Side impact Collision (t-bone, broadside)

Head remains still as body is pushed laterally causing injuries to the neck. Injury patterns include head, chest, abdomen, pelvis, and thighs as well as skeletal and internal injuries.

Carbon Monoxide poisoning

Headache dizziness, breathing difficulty, nausea, cyanosis, altered mental status; in severe cases, unconsciousness.

Cardiovascular system

Heart and blood vessels

Pre-hypertension

High Blood Pressure 120-139 Systolic 80-89 Diastolic

Stage 1 Hypertension

High Blood Pressure 140-159 Systolic 90-99 Diastolic

Stage 2 hypertension

High Blood Pressure 160+Systolic 100+Diastolic

Hot, moist skin temperature/ condition

High fever, heat exposure

Respiratory Sounds: Wheezing

High pitched sounds that seem almost muical in nature. Created by air moving through narrowed air passages in the lungs. Heard in medical problem such as asthma and sometimes Chronic obstructive lung diseases such as emphysema and chronic bronchitis. Mainly heard on expiration. Assist patient in taking prescribed medications; prompt transport

Illusionary Correlation

Humans are drawn to finding conclusions and seeing how one thing effects another. Very often , one event may appear to cause another, leading to an illusionary correlation. For example, pople belive floridated water causes cancer. It is true that communities that have fluridated water have a higher rate of cancer than rural areas. Therefore it's easy to conclude that one caused another. However, when you look more closely at the data, you discover that cities are more likely than rural areas to have fluridated water. Cities have higher rates of cancer than rural areas in general. Furthermore, cities that fluridate have the same incidence of cancer as cities that do not fluoridate. Therefore this appearance causes illusion. To avoid this line of thinking, consider how the apearance of two things together may just be a coincidence, or alternativly, consider they both may have the same cause. An easy way to remember illusionary correlation is to think "Most ice cream is eaten in the summer, most drownings occur during the summer, therefore icecream causes drowning."

asprin

INDICATIONS: All of the following must be met: 1) Patient complains of chest pain. 2)Patient is not allergic to aspirin 3)Patient has no history of Asthma 4)Patient is not already taking any medication to prevent clotting. 5)Patient has no other contraindications to asprin 6)Patient is able to swallow without endangering airway 7)Medical direction authorizes administration of the medication. CONTRAINDICATIONS: 1)Patient is unable to swallow without endangering airway 2)Patient is allergic or sensitive to asprin 3)Patient has a history of asthma (many people with asthma are allergic to asprin) 4)Patient has gastrointestional ulcer or recent bleeding 5)Patient has a known bleeding disorder. 6)Medical direction may decide if the benifit of giving aspirin to a patient who has one of the following conditions outweighs the risk: a.Is already taking medication to prevent clotting (including asprin) b.Pregnancy c.Recent surgery MEDICATION FORM Tablet; many EMS systems use baby asprin, usually supplied as 81 mg chewable tablets. DOSAGE: 162 TO 324 mg (two to four 81 mg tablets of chewable baby asprin). Aspirin does not usually need to be administered more than once in the early treatment of cardiac problems ADMINISTRATION: 1)Gather a history and perform a physical exam appropriate for a cardiac patient. 2) Contact medical direction, if no standing orders. 3)Ensure the right medication, right dosage, right patient, right time, right route. Check expiration date. 4)Ensure the patient is alert. 5)Ask the patient to chew (if directed by protocol) and swallow tablets 6)Record the administration, route, and time 7)Perform reassessment ACTIONS 1)Prevents blood from clotting as quickly, leading to increased survival after myocardial infarction. 2)When administered to cardiac patients, asprin is not being used to relieve pain. SIDE EFFECTS 1)Nausea 2)Vomiting 3)Heartburn 4)If patient is allergic, bronchospasm and wheezing 5)Bleeding REASSESSMENT STRATEGIES 1)Perform reassessment. 2)Evaluate the patient for new onset of difficulty breathing from bronchospasm 3)Any bleeding resulting from the asprin is very unlikely to occur before the patient arrives at the hospital 4)Record the assessments

Ventricle Tachycardia (V-tach)

If it is very fast. In ventricular tachycardia (an unusual cardiac arrest rhythm observed in less than 10 percent of all out-of-hospital cases), the heart rhythm is organized, but quite rapid. The faster the heart rate, the more likely it is that ventricular tachycardia will not allow the heart's chambers to fill with enough blood between beats to produce blood flow sufficient to meet the body's needs, especially that of the brain. Pulseless V-tach is considered a shockable rhythm Some patients with ventricular tachycardia are awake, even with very fast heart rates. If an AED is attached to one of these patients, it will charge up and advise shock. Since the patient has a pulse and is awake, the action would be inappropriate. This is one reason the AED should be attached only to patients in cardiac arrest

Hypertension

If someone has systolic of 140 or greater or a diastolic of 90 or greater

If you are unsure whether the patient in multiple-choice question 13 requires artificial ventilation, you should: A)contact medical direction immediatly B)move to the ambulance and transport rapidly C)increase the liter flow rate to the nonrebreather mask D)provide artificial ventilation

If you are unsure about whether a patient needs artificial ventilation, you should provide artificial ventilation (D)(p447)

IV Therapy

In advanced life support an intervenouse (IV) catheter is inserted into a vein so that blood, fluid, or medications can be administered diectly into the patients circulation system. Blood transfusions are almost always given at the hospital, whereas an infusion of other fluids and many medications can be done in the field. There are two ways fluids and medicationscan be administered in the vein. One is through a heparin or saline lock, the other is through a traditional IV bag. With the heperine or saline lock, the catheter is placed into the vein. A small cap or lock is placed over the end of the catheter that protrudes from the skin. This lock contains a port through which you can administer medication. There is no IV bag attatched to the saline lock. It is used in cases where fluid isn't likely to be administered, but the administration of medication and/or the need for IV access later on is likely. With the second way, the IV bag, a traditional IV bag hangs above the patient and constantly flows fluid to the patient. The bag of fluid that feeds the IV is usually a clear plastic bag that collapses as it empties. The administration set is the clear plastic tubing that connects the fluid nag to the needle, or the catheter. Three important parts to this tubing: 1)The drip chamber is near the fluid bag. There are two basic types: A)micro drip(also called the mini drip) used when minimal flow is needed (with children, for example) For example, 60 small drops from the tiny metal barrel in the drip chamber equal 1cubic centimeter (cc) or 1 millimeter(ml) B)Macro Drip-used when higher flow of fluid is needed(for a multitrauma patient in shock, for example). There is no lttle barrel in the drip chamber of the macro chamber and just 10 to 15 large drops equal to 1cc or 1 ml 2)Flow regulator-located below the drip chamber. It is a device that can be pushed up or down to start, stop, or control the rate of flow 3)The drug or needle port is below the flow regulator. The paramedic can inject medication into this opening. Steps in IV administration: 1) Take out and inspect fluid bag. Make surw to keepbag and protective wrapping clean. Remove wrapper, inspect it to make sure it has the appropriate fluid. Check expiration date to make sure fluid is usable, and look to see thay the fluid is clear and free of particles. Squeeze bag to check for leaks. 2)Select is proper administration set. Uncoil the tubing, and do not let the ends touch the ground 3)Connect the extension set to the administration set, if an extension set is to be used 4)Make sure the flow regulator is closed. To do this, roll the stopcock away from the fluid bag. 5)Remove the protective covering from the port of the fluid bag and the protective covering from the spiked end of the tubing. Insert the spiked end of the tubing into the fluid bag with a quick twist. Do this carefully and maintain sterility. If these parts touch the ground, they must not be used. Introducing germs or dirt directly into a patients bloodstream can be serious if not fatal. 6)Hold the fluid bag higher than the drip chamber. Squeeze the drip chamber a time or two to start the flow. Fill the chamber to the marker line (approximately one-third full) 7)Open the flow regulator and allow the fluid to flush all the air from the tubing. You may need to loosen the cap at the lowet end to get the fluid to flow. Maintain the sterility of the tubing end and replace the cap when you are finished. Most sets can be flushed without removing the cap. Be sure that all air bubbles have been flushed from the tubing to avoid introducing a dangerous air embolism into the patients vein. 8)Turn off the flow Make certain that the setup stays clean until the paramedic removes the needle and connects the IV tubing to the catheter inside the patients vein. Occassionally, the paramedic will draw blood from the vein to obtain samples before inserting the IV. You may be asked to assist by placing the blood sample tubes and labeling the tubes with the patient's name and other information that your hospital requires. Remember that these tubes are potential carriers of pathogens. Be sure to take Standard Precautions. Carry the blood tubes to a safe place where they will not be in danger of breaking. Don't be suprised if you are asked to hold a patients arm for a few minutes during cardiac arrest. During cardiac arrest, medications can be more effective if the arm is temporarily raised after a drug is injected into the IV.

Your 62-year-old female patient is going to need you to assist her ventilation. The best method for providing assisted ventilation is the: A)Pocket face mask with suplemental oxygen B)Two-rescuer bag mask device with suplemental oxygen C)flow-restricted, oxygen-powered ventilation device. D)one-rescuer bag mask device with suplemental oxygen.

In order of preference, the procedure for providing assisted ventilation is as follows: 1)pocket face mask with suplemental oxygen 2)two-rescuer BVM with suplemental oxygen. 3)Flow-restricted, oxygen-powered ventilator 4)One-rescuer BVM with suplemental oxygen (A)(p447)

Indications and contraindications for bronchodilators (inhalers)

Indications: 1)Patient exhibits signs and symptoms of respiratory emergency 2)Patient has physician-prescribed handheld inhaler 3)Medical direction gives specific authorization Contraindications: 1)Patient is not able to use device (e.g., not alert) 2)Inhaler is not prescribed for the patient 3)No permission has been given by medical direction 4)The patient has already taken the maximum prescribed dose prior to EMT arrival

Asprin

Indications: Patient complains of chest pain Patient not alergic to asprin Patient has no history of asthma Patient is not already taking medications that prevent clotting Patient has no other contraindications to asprin Patient is able to swallow without endangering the airway Medical direction authorizes administration of medication Contraindication: Patient is unable to swallow without endangering airway Patient is allergic or sensative to aspirin Patient has history of asthma (many people with asthma are allergic to aspirin) Patient has a known bleeding disorder Medical direction may decide if the benifit of giving aspirin to patient who has one of the following outway the risk A.already taking medications for blood clots (including asprin) B.Pregnancy C.Recent surgery Medication Form: Tablet; many EMS systems use baby asprin, usually supplied as 81 mg chewable tablet Dosage: 162 to 324 mg (two to four 81 mg tablets of chewable baby asprin) Asprin does not usually need to be administered more than once in the early treatment of cardiac problems Administration: Gather patient history and perform a physical exam appropriate for cardiac patients Contact medical directiob, if no standing orders Ensure right medication, right patient, right time, right dose, and right route. Check expiration date. Ensure patient is alert Ask patient to chew (if directed by protocal) and swallow tablets Record administration route, and time Perform reassessment Actions: Prevents blood from clotting as quickly, leading to increased survival after myocardial infarction When administered to cardiac patients, aspirin is not being used to relieve pain Side Effects: Nausea Vomiting Heartburn If patient is allergic, bronchospasm and wheezing Bleeding Reassment Strategies: Perform reassessment Evaluate the patient for new onset of difficulty breathing from bronchospasm Any bleeding resulting from the asprin is very unlikely to occur before the patient arrives at the hospital Record the assesment

nitroglycerin Nitrostat, Nitrolingual

Indications: Patients wirh reoccurring chest pain or a history of heart attack carry nitroglycerin. Nitroglycerin helps to dialate the coronary vessels, which supply the heart with blood. The drug is taken, when a patient has chest pains, he believes are cardiac in origin. Systolic blood pressure is greater than 100systolic Medical direction authorizes administration Indications: All of the following must be met: 1)Patient complains of chest pain. 2)Patient has history of cardiac problems 3)Patient's physician has prescribed nitroglycerin (NTG). 4)Systolic blood pressure is greater than 100 systolic 5)Medical direction authorizes administration of the medication Contraindications: include, patients who take medications to treat erectile dysfunction, such as sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis), or similar medication in the last 48 to 72 hours. Hypotension BP lower than 90/60 Patient has head injury Patient is infant or child Patient has already taken maximum prescribed dose. Since nitroglycerin causes a dialation of blood vessels, a drop in patient blood pressure is always a potential side effect. If this should occur, lay the patient in the supine position and call medical direction. Dosage and admin: Tablet, sublingual (under tongue spray) 1 dose, repeat in 5 minutes, if less than complete relief, if blood pressure remains above 90 to 100 systolic, and if authorized by medical direction Perform focussed assesment, take BP (systolic must be above 100) Contact medical direction if no standing orders Maximum of three dosages, reassess vital signs after Ensure right patient, right time, right medication, right dose, right route Ensure patient is alert Question patient on last dose taken Ensure understanding of route administration Have patient lift tongue, place tablet or spray dose under tongue (while wearing gloves) or have the patient place the tablet or spray under the tongue Have patient keep mouth closed with the tablet under his tongue (without swallowing)until dissolved and absorbed. Recheck patients blood pressure within 2 minutes Record administration, route and time Reassess patient Actions: Relaxes blood vessels Decreases work of heart Side Effects: Hypotension (BP lower than 90/60) Headache Pulse rate changes Reassessment Strategies: Monitor blood pressure Ask patient about effect on pain relief Seek medical direction before readministering Record assessments

Because the chest wall is softer in infants and children, they: A)must inhale twice the amount of air to breathe B)depend heavily on the diaphram for breathing C)grunt and gurgle whenever they breathe D)expend less energy than adults do when breathing

Infants and children depend more heavily on the diaphram for breathing because the chest wall is softer. They do not inhale twice the air, and they may grunt only when they are in respiratory distress. (B)(P.447)

Upper/Lower Airway Infection

Infectious disease may effect all parts of airway by obstructing air flow or exchange of gases.

The structure that divides the chest cavity from the abdominal cavity is called the___________muscle

Inguinal. This muscle is located at the base of the abdomen.

Characteristics of inadequate breathing (5)(9)(19)

Iniadequate breathing is breathing that is not sufficient to support life. 1)Breathing Rate above or below 12-20 Adult, 15-30 child, 25-50 for infant Bradypnea(slow breathing rate) or tachypnea(elevated or rapid breathing rate)may not allow enough air to enter the lungs. Agonal respirations (dying respirations) are sporadic, irregular breaths that are seen just before respitory arrest. They are shallow and gasping with only a few breaths per minute 2)Rhythm-irregular or regular. Rhythm. Is not an absolute indicator of adequate or in adequate breathing. Patient may have regular rate, even if breathing is inadequate from talking , anxiety or something else. 3)Quality-diminished or absent sounds Lung sounds are heard for example, strider, crackles (rales), wheezing, gurgling, rhonchi, crowing. Depth of respiration and chest expansion may be unequal or inadequate. Tidal volume (the amount of air moved in one cycle) will be inadequate or shallow. Decreased minute volume. Use of accessory muscles (e.g. muscles of neck and abdomen) in breathing. Skin may appear cyanotic (blue) or pale due to vaso constriction and feel cool to the touch. Diminished responsiveness. Unusual chest anatomy (barrel chest) flared nostrils. Tripod position. Pursed lips, pedal edema, sacral edema, numbness or tingling in hands or feet, straining intercostal muscles 3-4 word dyspnea in increasing respiratory distress. Increasing anxiety-nonrebreather mask 1-2 word dyspnea in severe respiratory distress+diaphoretic, severe anxiety (PFM)Pocket Face Mask (BVM)Bag Valve Mask (FROPVD)Flow restricted, oxygen powered ventilation device Vital sign changes may include: 1)Increased PR 2)Decreased pulse rate. (especially in infants and children) 3)changes in breathing rhythm 4)Hypertension or Hypotension 5)Oxygen Saturation or SpO2 reading less than 95% on pulse ox. Even a patient with a SpO2 reading within normal limits 96% to 100% should recieve oxygen if he has any signs of respiratory distress 1. Obstructed pulmonary vessels 2. Damaged aveoli 3. Obstructed air passages 4. Obstructed blood flow to lungs 5. Pleural space filled Appropriate oxygen order of preference 1)Pocket face mask with O2 2)Two rescuer bag-valve mask with o2 3)Flow restricted oxygen powered device 4)one rescuer bag valve mask with suplemental o2

Hypoxia

Insufficiency of oxygen in the body's tissues

Rotational Impact Collisions

Involving cars that are struck and then spin. Multiple injury pattern

Minute volume

MV = TV×RR Tidal Volume is typically 5-7 ml per kg of body weight. 1) Convert (body weight) pounds into kg to get TV. Watch chest rise and fall for a 30 second count for RR. Multiply TV ×RR to get your minute volume.

Respiratory Sounds: Crowing (harsh sounds when inhaling)

Medical problem that cannot be treated on the scene/prompt transport

Bronchodilator (inhaler)Dosage and administration

Medication Form: handheld metered-dose inhaler Dosage:Number of inhalations based on medical direction or physicians order Administration: 1)Obtain an order from medical direction, either online or offline. 2)Ensure correct patient, correct time, correct medication, correct dosage, correct administration route, and that patient is alert enough to use inhaler 3)Check expiration date 4)Check if patient has already taken any doses 5)Ensure inhaler is room temperature or warmer 6)Shake inhaler several times 7)Have patient exhale deeply 8)Have patient put lips on inhaler, depress handheld inhaler and inhale deeply 9)Instruct patient to hold her breath as long as possible so medication can be absorbed 10)put oxygen back on patient 11)Allow patient to breath oxygen a few times and repeat second dose if ordered by medical direction 12)If patient has spacer(device attatched to inhaler for better afministration of medication) for use with inhaler,allow them to use it.

Activated Charcoal

Medication used to treat a poisoning or over dose when a substance is swallowed and is in the patient's digestive tract. Activated charcoal will adsorb (bind to the surface of the charcoal) and help them from being absorbed in the body. Activated charcoal like bronchodilators is a suspension formula and the chemical composition will seperate in storage. It is important to shake prior to use. Medication Name: Generic: activated charcoal Trade:SuperChar, InstaChar, Actidose, Liqui-Char, and others Indications: Poisoning by mouth Contraindications; Altered mental status Ingestion of acids or alkalis Inability to swallow Medication Form: Premixed in water, frequently available in aplastic bottle containing 12.5 grams of activated charcoal PPowder-should be avoided in the field Dosage: Adultd and children: 1 activated charcoal/kg of body weight Usual adult dose 25 to 50 grams Usual pediatric dose:12.5 to 25 grams Administration: Consult medical direction Shake container thoroughly Since mefication looks like mud, the patient may need to be persuaded to drink it. Providing a covered container and a straw will prevent the patient from seeing the medication and so may improve patient compliance. If the patient does not drink the medication right away, the charcoal will settle. Shake or stir it again before administering of the medication Action: Activated charcoal adsorbs (binds) certain poisons and prevents them from being absorbed into the body. Not all brands of activated charcoal are the same. Some adsorb much more than others, so consult medical direction about brand use. Side Effects: Some patients have black stool Some patients may vomit, particularly those who have ingested poisons that cause nausea. If the patient vomits, repeat the dose once. Reassesment Strategies: Be prepared for the patient to vomit or further deteriorate

Bronchodilators

Medications that cause bronchial muscles (involuntary muscles) to relax. With medication, the bronchial tubes can usually open fully again and and breathing can become normal again. We say "usually," because sometimes the bronchial tubes are swollen and filled with mucus. This bronchial obstruction can often be heard in the form of wheezing as vibrations of air resonate through the trachea. This type of sound is refered to as bronchial breath sounds in Asthma patients as it is heard over the trachea on expiration and sometimes on inspiration. Wheezes suggest airway narrowing and flow limitations. If swelling and mucus are present then bronchodilators will only provide partial relief to the patient for asthma symptoms. In this case even when bronchial tubes are made to relax, bronchial tubes remain partially narrowed or blocked.

Pressure compensated flowmeter

Meter is gravity dependent, must be in an upright position to deliver an accurate reading. Unit has an upright calibrated tube in which there is a ball float. Float rises and falls according to the amount of gas passing through the tube. This type of flow meter indicates the actual flow at all times even though there may be partial obstruction to gas flow (eg kinked tube) If tube collapses, ball will drop to show lower delivery rate. Unit not practical for portable delivery. Reccomended for large (M, G and H) oxygen cylinders in the ambulance.

Increasing respiratory distress: Visibly short of breath; Speaking 3-4 word sentences; Increasing anxiety

Nonrebreather mask

Adequate breathing: Speaks full sentences alert and calm

Nonrebreather mask or nasal cannula

Pink skin significance/possible causes

Normal in light - skinned patients; normal at inner eyelids, lips, and nail beds of dark-skinned patients

Mottled (blotchy) skin color significance/possible causes

Occasionally in patients with shock

Absorbed Poison

Poisons taken through unbroken skin. Many are corrosives that will injur the skin others are absorbed into the bloodstream without injuring the skin. Examples include insecticides and ag chemicals Contact with certain plant material and marine life can lead to skin damage and possible absorption under the skin

Hemiparesis

One-sided weakeness. Because the left side of the brain controls movement on the right side of the body (and vice versa) someone with right sided weakness from a stroke actually has problems with the left side of his brain. However, the nerves in the face muscles do not necessarily crossover the same way, so sagging or drooping on one side of the face is not a reliable sign of injury on the opposite side of the brain. It is however, a good way to asses patients for stroke on the Cincinnati Prehospital Stroke Scale.

Hyperglycemia and Hypoglycemia compared

Onset: Hyperglycemia has a slower onset, whereas hypoglycemia comes on suddenly. This is because some sugar is still in the brain in hyperglycemic (high blood sugar readings over 140). With hypoglycemia (low blood sugar readings of 60 to 80 glucose meter) it is possible that no sugar is reaching the brain. Seizures may occur. Skin: Hyperglycemic patients often have warm red dry skin. Hypoglycemic patients have cold, pale, moist and clammy skin Breath:The hyperglycemic patient often has acetone breath (like nail polish remover) whereas the hypoglycemic patient does not. Also patients who are hyperglycemic (high blood sugar) frequently breath deep and very rapid. They have dry mouth, intense thirst and abdominal pain, vomiting are all common signs and symptoms of this condition

OPQRST: Present Illness

Onset: Was it sudden or gradual Provokes: Anything that makes it bettet or worse Quality: Describes how it feels, dull sharp pain etc Radiates: 1 spot or several others Severity: scale of 1-10 Time: What time did it happen? Used for chest pain, respiratory, abdominal patients.

OPQRST with breathing difficulty

Onset=O: When did it begin? Provocation=P: What were you doing whenthis came on? Have you been sshort of breath when exherting yourself Quality=Q: Do you have a cough and are you bringing anything up with it? Radiation=R:Do you have any pain or discomfort anywhere else on your body? Does it seem to spread to other parts of your body? Severity=S: On a scale of 0 to 10, 0 being no breathing difficulties and 10 being the worst, how would you bad is your breathing trouble Time=T: Has your breathing improved or gotten worse since we got here?

Hazards of oxygen therapy

Oxygen toxicity: patients whose lungs react unfavorably to the presence of oxygen or from too high a concentration. The body reacts sensing overload by reduced lung activity and air sac colapse. This is extremely rare in the field, but a very real danger. Infant eye damage (infants develop scars on the retina, oxygen itself is not the primary cause, but a combination of factors. Respiratory depression or arrest: patients with end stage copd may lose the ability to use blood carbon dioxide as a stimulus to breath. This causes the body to use low blood oxygen to stimulate breath thorough this so called hypoxic drive. As with any patient, use pulse oximetry to help determine oxygen saturation and appropriate administration levels. Other dangers include, combustible cylinder, puncture danger, and dangers of oil and oxygen.

Angina Pectoris

Pain in the chest, which occurs when blood supply to the heart is reduced and a portion of the heart muscle is not recieving enough oxygen. In this condition, coronary artery disease has narrowed the arteries that supply the heart. During times of exertion or stress, the heart works harder. The portion of the myocardium supplied by the narrow artery becomes starved for oxygen. Since the initial onset comes on after stress or exehertion, the pain will frequently diminish when the pain stops the exertion. As the oxygen demand of the heart returns to normal, the pain subsides. Seldom does this painful attack last longer than 3 to 5 minutes Possession of nitroglycerin is another indication that the patient has this condition. Nitro dilates the blood vessels, this results in more blood staying in the body, so there is less blood coming back to the heart. With less blood to pump out, the heart doesn't have to work as hard. Most angina patients are advised by their physician to take Nitro for chest pain. Patients are told to rest and allowed to take three doses of Nitro over a 10 minute period. If there is no relief of symptoms after that time, they are instructed to call for help.

When assesing the chest of an adult female critical trauma patient, the EMT should inspect/palpate for ____________ in addition to crepitation and deformaties

Paradoxical motion

Expiration is a _______process in which the intercoastal muscles and the diaphram_________, causing the chest cavity to ___________in size and force air ________the lungs

Passive process, diaphram relax, chest cavity decrease in size, force air from the lungs

Multiple casualty incident(MCI)

Patients in multiple casualty incidents may be moved from one patient area to another. Use triage tags to record the patients chief complaints, injuries, vital signs and treatment given.

Pulmonary edema

Patients with (CHF) congestive heart failure may experience difficulty bteathing because of fluid that accumulates in the lungs, preventing them from breathing adequately. The abnormal accumulation of fluid in the alveoli of the lungs is known as pulmonary edema. It typically occurs because the left side of the heart has been damaged, often by myocardial infarction (heart attack) or chronic hypertension. Since the left side of the heart recieves blood from the lungs, the inability to pump blood out results in pressure up and going back into the lungs. In normal breathing, small airsacs in our lungs (alveoli) fill up during each breath taking essential oxygen O2 and getting rid of CO2 Carbon Dioxide. If the alveoli are flooded, two problems occur; the blood stream can not get its proper supply of O2, and the body is unable to get rid of CO2. This leads to poor perfusion and poor repiratorepiratory function. Since there is only one layer of cells lining the alveolus and one layer of cells covering adjoining capillaries, when pressure builds up, it is relatively easy for fluid to cross this thin barrier and to accumulate in the alveoli. If fluid occupies the lower airways, it, is difficult for oxygen to reach the blood and the patient experiences dyspnea. Patients with CHF, often havr both left-sided heart failure and right-sided heart failure. Since the right side of the heart recieves the blood from systemic circulation (everything besides the lungs), pressure backs up into the cystemic circulation. This becomes visible as edema (from a greek word, meaning swelling) in the lower parts of the body, typically the lower legs. In Peripheral or pedal edema, it selling and fluid build up is often noticeable in the ankles and feet by "pitting". Peripheral edema is most often associated with aging ;however it's causes may vary. In bed ridden patients the lower legs are not the lowest part of the body. Instead, fluid accumulates in the sacral area of the lower back. Sometimes CHF patients will have jugular vein distension (JVD), buldging of the neck veins, and accumulation of fluid in the abdominal cavity. When a patien lies down at night to sleep, the fluid in the bodymoves back into the circulation. This means it can easily overload the system and leak into the lungs, leading at first to mild dyspnea that can be relieved by sleeping propped up on one pillow, then two pillows or even three pillows. At some point the amount of fluid becomes to much and the patient awakens acutely short of breath, with the feeling of that he is drowning. If the patient can speak, he may tell you that he has been feeling worse each night for the last several days. He may have noticed weight gain. Signs and symptoms include anxiety, pale and sweaty skin, tachycardia, hypertension, respirations that are rapid and labored, and low oxygen saturation. In severe cases,you may hear gurgling sounds from the lungs, even without a stethescope, each time the patient breathes. When you ausculate the lungs, you will hear crackles and sometimes wheezes. In severe cases, patient coughs up frothy sputum, which is usually white but sometimes pink-tinged. Treatment includes high-concentration oxygen mask unless patients breathing is inadequate and you need to ventilate the patient. If at all posdible keep the patient's legs in a dependent position (hanginng down). Brining the legs up pushes more fluid into the already overloaded circulatory system and makes matters worse. As mentioned in some of the other note cards, CPAP can be very useful in these patients since it can physically push fluid back out of the lungs and into the capillaries where it belongs. Although most cases of pulmonary edema you will see will be a result of heart failure or MI (myocardial infarction), there are some noncardiac causes. For example, some people when exposed to low atmospheric pressure of high altitudes may develop pulmonary edema. In this case, the heart is fine. The inportant treatment for these patients is to bring them back to normal altitude and atmospheric pressure. Administer high concentration of oxygen. Although traditionally called CHF Congestive heart failure, this conditionis now called heart failure to reflect the reality that many patients don't develop congestion (with blood) of the body's organs. The condition, whatever it is called, is quite common and is fortunatly more treatable than it has been previously. Many patients are living longer healthier lives due to stict diet, modifications 3(low sodium), modern pharmacology, and in some cases the use of advanced electronic pacemakers that make the heart beat more effeciently

Injected Poisons

Poisons inserted into the skin. The most common is illicit drigs injected and venoms injected by snake fangs or insect stingers

Pneumonia

Pneumonia is an infection of one or both lungs caused by bacteria, viruses, or fungi. It results from the inhalation of certain microbes that grow in the lungs and cause inflamation. People with COPD or other repiratory diseases are more likely to get pneumonia. People with chronic health problems are also at risk. Some of the most common signs and symptoms include coughing, (mucas can be greenish, yellow, or occasionally bloody), fever, chest pain, and severe chills. Most, but not all, patients complain of dyspnea,either without exertion; chest pain and sharp and pleuritic (worsens on inhalation);headache;pale, diaphoretic, ;fayigue; and confusion, especially in elderly. Sometimes an older person will have only a few signs and symptoms besides confusion. When you ausculate the chest, you may hear crackles on one side in just one region. Prehospital care consists of supportive treatment that you would administer to any patient with difficulty breathing. If pneumonia is thought to be bacterial the patient will recieve antibiotic treatment at the hospital. Imunization with a vaccine that prevents most forms of bacterial pneumonia is is an important and effective part of prevention for elderly with chronic health conditions.

Ingested poisons

Poisons that are swallowed. These include common household and industrial chemicals, medications, improperly stored food, plant materials, petroleum products, agricultural products made specifically to control rodents, weeds, insects, and crop diseases

Confidentiality

Pre hospital care reports (PCR) and info contained within are to be kept strictly confidential. Information must not be discussed with unauthorized persons. HIPAA requires that EMT's must take steps to safeguard confidentiality

Assessment of diabetic patients

Prehospital Identification of the diabetic patient depends on rapid identification of the patient with an altered mental status and a history of diabetes. To assess the patient: 1)Ensure a safe scene. People with diabetic emergencies can be agitated and some times violent. Always make sure the scene is safe for yourself and your crew before approaching a patient with an altered mental status 2)Perform a primary assesment, identify altered mental status 3)Perform secondary assesment. Gather history from patient or bystanders: *Gather a history of the present episode. Ask about how the episode occured, time of onset duration, associated symptoms, any mechanism of injury or other evidence of trauma, whether there have been any interruptions to the episode, seizure, or a fever. *During the SAMPLE history, determine if the patient has a history of diabetes. Question the patient or bystanders about such history. Look for medical identification of a diabetic patient bracelet, wallet card, or other identification ofa diabetic condition such as a home-use blood glucose meter. Look in refrigerator or elsewhere for medications such as insulin, a medication with the trade name for insulin (such as Humilin), or an oral medication used to treat diabetes (such as metformin, Glucotrol, Glucophage, Micronase). Some diabetics will have small pumps about the size of an mp3 player and usually worn on the belt: The pump will have a small catheter that enters into the abdomen. Also ask about patients last meal. last medication dose, and any related illness *Perform blood glucose monitoring if local protocols permit you to do so, (See the information in the next section) 4)Determine if patient is alert enough to swallow 5)Take the baseline vital signs. (In some jurisdictions, oral glucose will be administered before the vital signs are taken) The following signs and symptoms are associated with diabetic emergency *Rapid onset of altered mental status *After missing a meal on a day the patient took prescribed insuline *After vomiting a meal on a day the patient took prescribed insulin *After an unusual amount of physical exercise or work. *May occur with no identifiable predisposing factor *Intoxicated appearance, staggering, slurred speech, to unconsciousness *Cold, clammy skin *Elevated heart rate *Hunger *Uncharacteristic behavior *Anxiety *combativeness *Seizure

Prehospital care

Prehospital care report serves as a record of patient care, serves as a legal document, provides information for administrative functions, aids education and research, and contributes to quality improvement.

When assesing the pelvis of an adult male critical trauma patient, the EMT should inspect/palpatate for ____________in addition to wounds, deformities, and tenderness

Priapism

Rollover Collision

Rollover patterns frequently cause ejection for anyone wearing a seat belt.

Right Atrium

Recieves deoxygenated blood from the heart

Parenteral

Referring to a route of medication administration that "does not use the gatrointestional tract," such as an intervenous medication. Another example would be epinephrine auto injector

Enteral

Referring to a route of medication administration that "uses the gastrointestinal tract," such as swallowing a pill. Another example is liquids to be taken orally (like cough syrup)pg432

Representativeness

Representativeness means that when you encounter a patient with a certain group of signs or symptoms that resemble a particular condition, you assume the patient has that condition. Representativeness is at the heart of pattern recognition and is an important heutistic. What is the disadvantage? Patients don't always present with the typical signs and symptoms of condition. As a result, when a patient doesn't fit the classical pattern, it's easy for healthcare providers to mistakingly conclude the patient doesn't have the condition. For example, older patients with myocardial infarctions sometimes deny chest pains andcomplain instead of dyspenea or weakness as their chief complaint. To avoid this trap, remain aware of it's possibility. Remind yourself that patients don't read text books and can present with uncommon atypical signs or symptoms. "If it looks like a duck and quacks like a duck, it must be a duck, except when it's isn't"

Priorto adminstering a medication to a pation, you must know...

Route of administration, proper dosage and action medication will take. Although knowing the generic name and chemical formula are good pieces of information to know, as an EMT you are not expected to know that.(p.433)

Status Epilepticus

Seizures usually last no more than 1 to 3 minutes. (sometimes 5 in the clonic phase) When a patient has two or more convulsive seizures lasting 5 to 10 minutes or more without regaining full consciousness, it is known as status epilepticus. This is a high priority emergency transport. and possible ALS intercept. Paramedics must open airway and suction and administer high concentration oxygen

Biphasic

Sends shock in one direction and then the other. This kind of machine typically measures the impedance or resistance between the two pads and adjusts the energy accordingly, delivering more energy when the impedance is higher and less when its lower. These features allow biphasic AED's to use less energy and perhaps cause less damage to the heart. Use of biphasic AED's does not result in higher survival rates, but they are at least as good as monophasic machines and have other advantages. Because the battery doesn't need much energy, they are smaller and lighter than monophasic AED's a significant factor when an EMT has to carry several heavy pieces of equipment at once.

Monophasic defibrillator

Sends single shock from the negative pad or paddle to the positive pad or paddle.

Stretch receptors

Sensor in the blood vessel designed to identify internal pressure

Pulse Quality: Rapid, Regular, Thready

Shock, later stages of blood loss

Heuristics

Short cuts that physicians use that speed up the process of reaching a diagnosis, The short cut is based on pattern recognition. It helps make physicians more efficient clinicians by narrowing diagnostic possibilities, ruling out others in order to come up with conclusions

Constricted Pupils (smaller than normal)

Significance/Possible causes Drugs (narcotic4s), prescription eye drops

Pupils (lack of reactivity)

Significance/possible causes Drugs, lack of oxygen to brain

Dilated pupils (larger than normal)

Significance/possible causes Fright, blood loss, drugs, prescription eye drops

Unequal Pupils

Significance/possible causes Stroke, head injury, eye injury, artificial eye, prescription eye drops

Cold, Moist Skin temperature/condition

Significance/possible causes: Body is losing heat

Cold, dry Skin temperature/condition

Significance/possible causes: Exposure to cold

Hot, dry skin temperature/condition

Significance/possible causes: High fever, heat exposure

High Blood Pressure

Significance/possible causes: Medical condition, exertion, fright, emotional distress, or excitement

Cool and clammy Skin temperature/condition

Significance/possible causes: Sign of shock, anxiety

Pulse Quality: Rapid, regular and full

Significance/possible causes: Exertion, fright, fever, high blood pressure, first stage of blood loss

SAMPLE: Medical History

Signs and Symptoms, Alergies, Medications, Past Pertinent medical history, Last Oral Intake, Events leading to illness. Used on every patient.

The neck veins are not visible when the patient is ____________.

Sitting up

You are treating an unresponsive adult male patient. If he is making__________sounds, he may have a serious airway problem requiring immediate intervention. A)snoring and gurgling B)slight wheezing C)sniffling D)whistling or grunting

Snoring and gurgling sounds usually indicate partially obstructed airway. Wheezing can be a sign of anything from airway obstruction to bronchoconstriction. Sniffling is usually from a runny nose. Whistling and grunting is a distracter. (A)(P450)

Run data

Space for run data may be included at the beginning or end of the report. Information considered run data includes: 1)Agency Name 2)Date 3)times 4)call number 5)unit personnel 6)All levels of certification 7)basic info mandated by your agency

Indications (For Medications)

Specific signs and circumstances under which it is appropriate to administer a medication to a patient

Contraindictions (For medications)

Specific signs or circumstances under which it is not appropriate, and may be harmful, to administer a drug to a patient

Uppers

Stimulants that affect the central nervous system and excite the user. Many abusers attempt to relieve fatigue or create feelings of well being. Examples are caffeine, amphetamines (speed, go pills)and cocaine

A common result of injured capillaries bleeding under the skin is called.

Swelling

Blood Pressure Normal Ranges: Infants and children

Systolic: Approx. 80 + 2 × age Diastolic: Approx. 2/3 systolic

Blood Pressure Normal Ranges: School age 6 to 10 years

Systolic: Average 105 (80 to 115) Diastolic: Average 69

Anaphylaxis: Anaphylaxis is a life-threatening response of the immune system. Anaphylaxis affects major systems such as the circulatory and respiratory systems and, if untreated, can cause death Anaphylaxis begins when the body over reacts to an antigen. Common causes of anaphylaxis are bee stings, peanut butter, and medication allergies The allergic reaction (begun when an antigen meets antibodies within the body) causes the body to release a variety of substances, including hisyamine, which causes vasodilation and shock as well as bronchconstriction These substances also alter vascular permeability, allowing fluid to enter and swell the airways, lips, tongue and throat

The epinephrine auto-injector carried by patients and on many ambulances provide immediate and significant benifit to those suffering from anaphalaxis. Epinephrin causes vasoconstriction (which reverses shock) ny acting on the alpha receptors of the sympathetic nervous system. It reduces vascular permeability and the edema found in the face and airways. Epinephrine also causes bronchodilation to open constricted bronchodilation to open constricted bronchioles through the beta receptors in the sympathetic nervous system

Congestive heart failure CHF

The failure of the heart to pump efficiently, leading to excessive blood or fluid in the lungs, the body, or both

Tachypnea

The medical term for increased rate of respiration. The normal RR is between 12-20 for adults. Anything over that is considered tachypnea. Also known as rapid breathing. Common in people who have emphysema either because they are not getting enough oxygen or they are trying to "blow off" excess carbon dioxide. (Waste product of metabolism) which is built up in their blood because of inadequate expulsion of inhaled air. Example: The patient is showing signs of tachycardia (elevated heart rate)as well as tachypnea.

Causes of Seizures

The most common cause of seizures in infants and children 6 moths to 3 years of age is high fever. (febrile sizures) others include: 1)Hypoxia-lack of oxygen 2)Stroke-Clots and bleeding in the brain 3)Traumatic Brain Injury-Brain injuries can cause seizures, so can scars that form on the site of previous brain injuries 4)Toxins-Drug or alcohol use, abuse or withdrawl 5)Hypoglycemia-Low blood pressure Glucose meter reading 60-80 6)Brain tumor-Brain Tumors may occasionally cause seizures 7)Congenital brain defects-Seizures due to congenital defects of the brain (defects one was born with) are most often seen in infants and young children 8)Infection-Swelling or inflamation of the brain caused by infection can cause seizures 9)Metabolic-Seizures can be caused by iregularities in the patients body chemistry (metabolism) 10)Idiopathic-This means occuring spontaneously, with an unknown cause. This is often the case with seizure that start in childhood.

Insulin

The pancreas is an organ found along the midline of the upper abdomen. The pancreas has a variety of functions, but one of it's most roles is the production of the hormone insulin. Within the pancreas specialized clusters of cells called the islets of Langerhans secrete insulin. Insulin secreted in the body helps transfer glucose from blood across cell membranes. The insulin glucose relationship has been decribed as a "lock and key" mechanism. Consider insulin the key. Without the insulin "key", glucose cannot enter the locked cells. When sugar intake and insulin production are balanced, the body can effectively use sugar as an energy source.

Chief Complaint

The reason EMS was called

You are standing at the finish line at a 5k road race when a runner crosses the line and is suddenly in distress. He is very thin and tall, and complaining of sudden sharp pain when he breathes. What is most likely his respiratory condition? A)spontaneous pneumothorax B)Pulmonary embolism C)cystic fibrosis D)a viral respiratory infection

The thin healthy runner in this "classic" scenario is most likely to have sustained a spontaneous pneumothorax by bursting a bleb on the wall of his lung. When blebs "pop" inhaled air is able to travel from the airways to the thoracic cavities creating pneumothorax. Lungs are made up of lung tissue itself consisting of alveoli, bronchi, bronchioles and a thin membrane covering called pleura. Blebs and bullae are both blister like air sacs or air pockets that form on the surface of the lung. Blebs can often effect young healthy people as in our "classic" example; however, bullae may be associated with COPD, emphysema and part of the picture in cystic fibrosis. The patient with collapsed spontaneous ppneumothorax, auscilation will reveal breath sounds that are decreased or absent on on the side with the injured lung. This test is not reliable, however, as some patients with pnuemothorax may have perfectly normal breath sounds. Treat patients with pneumothorax like any one else symptomatic of dyspnea by administering oxygen. CPAP is contraindicated in patients with suspected pneumothorax. Most patients with pneumothorax will need a small catheter or larger plastic chest tube inserted between the ribs, then into the plueral space around the collapsed lung. The catheter will help remove the air, allowing the lung to re-expand. Because this was the "classic" example of the young thin runner, for testing purposes we can assume that the best correct answer is (A)Spontaneous Pneumothorax. (Pp. 458-459)

Confirmation bias

This happens when a clinician looks for clues to support the diagnosis he already has in mind. By doing so, he may overlook evidence that refutes or reduces the probability of that diagnosis. This occurs when a clinician is presented with a lot of information, and feels it's easier to go with one diagnosis than look for others. To avoid this pitfall, look for contrary data and consider a competing hypothesis. The tendency to look for information that supports what you already think is reflected in the statement "It must be right, I thought of it."

Head on collision

Two types of injury patterns: 1) Up and over-patient follows pathway over steering wheel, striking head on windshield, head and neck injuries, chest and abdomen on steering wheel and internal organ injuries 2)Down and under- patient's body follows a pathway down and under the steering wheel, striking knees on dash, knee leg and hip injuries

Availability

Urge to think of things because they are more easily recalled, often because of a recent exposure. For example, if an EMT has a patient with chest pain who diagnosed with a dissecting thoracic aneurysm, the next time he sees a patient with chest pain, he is more likely to think of dissecting thoracic aneurysm as a possibility, even though the condition is much less common than angina and myocardial infarction. Because of recent exposure to this condition, he may overestimate it's frequency. One way to think of the problem of availability is to say "You have the same thing my last patient had."

Generic: epinephrine Trade Name: Adrenalin Delivery system: EpiPen, EpiPen Jr, Twinject (adult or child size)

Used fpr patients who are highly alergic to something like shellfish, penicillin or a bee sting, may have a very severe reaction that may cause life-threatening changes in the airway and circulation. The reaction can be reversed by using epiniphrine which is a vasoconstrictor. It helps constrict the blood vessels and relax airway passages. Because severe alergic reactions may reach cause life threatening changes in the airway and circulation in a very short time, epinephrine must be administeted very quickly. Many patients prone to severe allergic reactions carry an epinephrine auto-injector. This syringe with a spring loaded needle will release and inject epinephrine into the muscle when the auto-injector is pushed against the thigh. Indications: Patient exhibit signs of severe alergic reactions, including either respiratory distress or shock (hypoperfusion, decreased blood flow to an organ) Medication is prescribed for this patient by a physician or is carried on the ambulance Medical direction authorizes use for this patient Contraindications: No contraindications when used in life threatening situations Medication Form: Liquid is administered by an auto-injector an automatically injectable needle and syringe system Dosage: Adult:one adult auto-injector (0.3 mg) Infant and child: one infant/child auto injector (0.15mg) Administration: Obtain patients prescribed auto injector. Ensure: A. ptescription is written for the patient who is experiencing the severe alergic reaction or protocols carrying the auto-injector on the ambulance B. Medication is not discolored (if visible) C. Medication has not expired Obtain an order from medical direction, either ofline or online Remove safety cap(s) from the auto injector Grasp the center of auto injector (to avoid potentially injecting yourself) Place the tip of the injector against the patients thigh A. Lateral portion of the thigh B midway between the waist and the knee Push injector firmly against thigh until injector activates. Hold the injector firmly against the thigh until the injector activates Hold the injector in place until the medication is injected (at least 10 second) Record adminstration and time Dispose of a single dose injector, such as the Epipen in the biohazard container, save a two dose injector, such as the twinject, and transport it with the patieny in case the second dose is required later. Actions: Dialates the bronchioles Constricts blood vessels Makes the capillariea less permeable (leaky) Side Effects: Increased heart rate Pallor (an unhealthy paleness caused by shock or illness) Dizziness Chest pain Headache Nausea Vomiting Exitability, anxiety Reassesment strategies: Transport Continue secondary assesment of airway, breathing, and circulatory status. If patient's condition continues to worsen (decreasing mental status, increasing breathing difficulty, decreasing blood pressure): A. Obtain medical direction for an additional dose of epinephrine B Treat for shock (hypoperfusion, decreased blood flow through an organ) Prepare to initiate basic life support procedures (CPR, AED) If patients condition imptoves, provide supportive care: Continue oxygen Treat for shock (hypoperfusion,decreased blood flow through an organ)

Viral Respiratory Infections

Viral respiratory infections often start with sore throat, sneezing, runny nose and feeling fatigue. There may be fever and chills; moreover, the infection may spread to the lungs causing dyspnea, especially to those with chronic health conditions and weak immune systems. The cough typically produces yellow or greenish sputum that lasts for about one to 2 weeks. Respiratory infections are very similar in sign and symptom to that of other illnesses, so the EMT should administer oxygen and give care consistent with any other patient with respiratory distress. Due to the viral nature of the infection, antibiotics often do more harm than good by destroying good bacteria thus renduring their immune systems antiobiotic resistant. Good hygiene and following universal precautions are your best defense against viral infection.

Minute Volume

Volume of air moved in one minute volume

Emphysema

Walls of alveoli break down, greatly reducing the surface area for respiratory exchange. The lungs begin to lose elasticity. The factors combine to allow stale air laden with carbon dioxide to be trapped in the lungs, reducing the effectiveness of normal breathing efforts. From http://emtsstudentpage.com/hypoxic_drive.htm Thanks Tom COPD Hypoxic Drive Nut Shell from medical book: The hypoxic drive theory is a result of chronic CO2 retention not the other way around. The body has a high CO2, low oxygen, and low pH( whether it's due to respiratory or metabolic) drive to breath. As the body becomes accustomed to chronic CO2 retention the pH normalized (by bicarb increasing or compensating), low oxygen becomes the drive to breath. That is why chronic CO2 retainers are more sensitive to oxygen. Here is my explanation using my simple "Tom level of thinking": Normal Breathing: The central chemoreceptors, also in the medulla, sense high CO2 levels. The carotid peripheral chemoreceptors sense low O2 levels. What are normal arterial blood gas levels (ABG): O2 is 80-100% normal range CO2 is 35 to 45% normal range PH is 7.35 to 7.45 normal range How does the flip in receptors take place - general rule: First look at the 02 Levels: Due to COPD (chronic bronchitis and emphysema) we still get O2 in but not as effective. So over time the carotid chemoreceptors start to adjust to a lower level of O2 in the blood. It is a gradual change over time so the body will adjust. Secondly look at the CO2 Levels: Due to COPD (chronic bronchitis and emphysema) we still get CO2 out but not as effective - so we "retain" a higher level of CO2. So over time the central chemoreceptors start to adjust to a higher level of CO2 in the blood. It is a gradual change over time so the body will adjust. As the CO2 sensor is exposed to increased levels it gradually has a lowered response. So the O2 sensors take over. When does the flip happen? When the CO2 levels rise from normal (35 to 45%) to greater than 60%. When the O2 levels drop from normal (80 to 100%) to less than 60%. When this happens we start to register not CO2 levels as much but the O2 levels. So when we saturate the body with high flow O2 for example the body registers the increase and says we have enough O2 slow down the breathing. "The Hypoxic Drive" The goal is to maintain the levels that the patients body is used to... a little hypercapnic (higher CO2) and a little hypoxic (low O2 level). That's why a pulse-ox sat of 90-92% is acceptable in a COPDer. Do not confuse pulse-ox and ABG numbers. Pulse-Ox of 95 to 100% is normal range and ABG O2 normal levels are 80 to 100%. The key to all of this: Just watch the pH. As a result of the increase of CO2 in the body the COPDer has to fight off more/higher acid levels. CO2 is acid. As long as the Ph level is acceptable (7.35 to 7.45) we are looking good. So who stops breathing? The COPD "retainer." When the ABG Ph is normal and the CO2 levels sky rocket as a result of ineffective respiration/ventilation exchange (most commonly cause by a breathing medical emergency expisode). These COPD "retainers" are very rare to see. They are the ones who stop breathing over time. A major majority of COPDers exchange the CO2 in and out just fine so they will not stop breathing. To recap it is the COPDers who retain the CO2 when in crisis and not release it in addition to the normal COPD hypoxic drive problems (lower O2 - higher CO2 levels) that stop breathing. Do not forget about the CSF (cerebrospinal fluid) Ph levels play a role in this also as they are influenced by CO2 (acid). And, of course, in an emergency give 100% O2. Source: Tom Copyright © 2013 Emergency Medical Training Services Last modified: 10/21/2013

Preventing food poisoning

Washing hands, utensils, cutting boards, and any surface the food touches before and especially after contact with raw meat, fish, or poultry (bacteria can easily be spread to other foods from hands or surfaces); by storing and cooking foods at appropriate temperatures and not by leaving raw or cooked foods at room temperature

BiPap

biphasic continuous positive airway pressure: 2 pressures. Inspiratory positive airway (Ipap)and expatory positive airway (epap) ipap controls flow of inhalation, epap controls flow of exhalation. It is important to maintain the appropriate balance between ipap and epap during ventilation to avoid over oxygenation.