1
Q
definition of a sharp
A
any sharp object that can introduce infection into the body’s system
2
Q
examples of sharps
A
needles, IV tubing, lancets, razors, ampules, scissors, scalpels, broken or intact glass preloads
3
Q
non conventional sharps
A
metal-MVCs, glass-MVCs, bone fragments
4
Q
common areas of inappropriate sharp disposal
A
pocket, mattress, under shoe/boot, shelf, floor
5
Q
appropriate sharp disposal
A
sharps bin
6
Q
unacceptable sharp safety
A
unsafe recapping, gesturing with sharp, reintroducing same needle into 2nd attempt if 1st was unsucessful, passing off sharps
7
Q
PPE for medication administration
A
gloves are routine
if nebulizing, mask and goggles should be worn
8
Q
6 rights
A
right pt, right drug, right route, right time, right dose, right documentation
9
Q
what needs to be documented in med admin
A
drug name, drug dose, time administered, route given, name of paramedic who gave the med, pts response to drug
10
Q
enteral medication administration
A
any drug that enters the body via the GI tract. absorbed at a slow rate
capsules, time-released capsules, lozenges, pills, tablets, elixirs, emulsion, suspensions, syrups
11
Q
parenteral medication administration
A
any route other than through GI tract. absorbed more quickly and more predictably.
IVs, needles, given from vials/amps
30-60s
12
Q
reconstituting drugs
A
adding liquid (NS or sterile water) to a dry medication
13
Q
medical asepsis
A
as clean as possible but not quite sterile. used to prevent secondary infections
14
Q
PO med admin
A
by mouth. absorbed slowly from the stomach and intestines. rarely given pre-hospital
usually 30-90 minutes
15
Q
SC med admin
A
given in the loose connective tissue between the dermis and muscle layer. given by a 24-26G needle. often given in the upper arms, anterior thighs, and abdomen. can only give max. 1ml
15-30 mins
16
Q
IM med admin
A
needle penetrates the dermis, subcutaneous tissue and into the muscle layer. often given in the lateral thigh, deltiod, gluteal area, and rectus femoris muscles. allows more mls to be administered
10-20 mins
17
Q
SL med admin
A
given under the tongue. rapidly absorbed
3-5 mins
18
Q
BUC med admin
A
between the cheeks and gums. rapidly absorbed
19
Q
IN med admin
A
nasal spray. given using a mucosal atomizer device. rapid absorption and onset
20
Q
INH med admin
A
either MDI or NEB.
MDI should be administered with an aero chamber to get the full dose of medication.
NEB must be hooked up to 6-8lpm of oxygen. minimum volume is 2.5mls (add NS if needed)
2-3 mins
21
Q
purpose of IV therapy
A
restore and replace volume and administer medications
22
Q
intracellular fluid
A
includes all fluids in the cells. 45% of total body weight
23
Q
extracellular fluid
A
fluid outside of the cell. Intravascular and interstitial. 15% of total body weight
24
Q
intravascular fluid
A
in the blood vessels
25
interstitial fluid
outside the vasculature but not in the tissue
26
TKVO
to-keep-vein-open
≥2-<12: 15mls/hr
≥12: 30-60mls/hr
27
bolus
20ml/kg
28
arteries
away from heart. have thick muscluar walls. consist of inner, middle, and outer layers.
IV should not ever be placed here
29
veins
consist of inner, middle, and outer layers. have valve to prevent backflow.
IV should always be placed here
30
capillaries
have thin walls. site of gas exchange
31
inner layer/tunica intima
endothelial lining forms the valves. promotes unidirectional blood flow towards the heart and prevents backward flow
32
middle layer/tunica media
less developed. location of nerve endings, elastic type tissue. weaker muscle coat, can collapse when blood pressure falls
33
outer layer/tunica adventitia
thinner, less elastic type properties. superficial- does not pulsate
34
macro drip sets
most commonly utilized admin sets. effective for both TKVO and bolus. come in 10, 15, 20 gtts/ml
35
micro drip sets
useful in controlling percise amounts of fluid. used to deliver medication over a long period. always 60 gtts/ml
36
buretrol
used in pts where fluid overload is a concern (peds, elderly, CHF)
use OSCAR (open squeeze close and release) when using a buretrol
37
saline locks
utilized instead of hanging a bag of fluid. still allows for quick access to the vein. reduces chances of fluid overload. easier to move pts (no tubing in the way)
38
angio cath
plastic catheter over a hollow needle
39
intra cath
plastic catheter inserted through a hollow needle
40
autoguard shield
designed to have needle retract into an elongated hub. activated by pressing a white button
41
catheter size selection factors
protocol, size of vein, pt age/condition, nature of infusion
42
adult catheter sizes
14G, 16G, 18G, 20G
orange, grey, green, pink
43
elderly catheter sizes
18G, 20G, 22G
green, pink, blue
44
pediatric catherter sizes
22G, 24G
blue, yellow
45
crystalliods
dissolving crystals such as salts and sugars in water. contains no proteins.
remain in the intravascular space for only a short time before diffusing across the capillary walls into the tissue
NS and LR
46
colloids
contain large molecules such as protein. do not pass through capillary membrane as readily as crystalliods.
whole blood and plasma
47
hypotonic solutions
lower solute in the solution than the cell. causes water to go into the cell. (NS, LR)
48
hypertonic solutions
higher solute in the solution causes water to leave the cell
49
isotonic solutions
equal inside and outside the cell
50
solutions a PCP can monitor without an escort
NS, LR, D5W, potassium chloride, thiamine, multivitaimins, saline locks
51
solutions that require a escort
blood products, medication being infused, IV pumps, central lines, jugular lines
52
checking the IV solution
must check for: leaks/precipitation, solution name, expiration date, cloudiness/discolouration
53
primed bags
good for 24-48 hours, must mark the date, time and name on a preprimed bag
54
IV site selection
distal sites should be used first. larger veins are easier to cannulate. avoid using dominant arm or placing one over a joint. pick based on vein stability and visablilty
55
contraindicated IV sites
presense of an AV fistula, anticipated location of surgery, veins that are firm or sclerosed, evidence of phlebitis or thrombosis, lymph node removal, mastectomy (if only on one side)
56
peripheral vasodilation
will help successfully cannulate. tourniquet, gravity, mechanical stimulation, muscular activity, application of heat
57
common causes of unsuccessful attempts IV insertion
angle of entry too steep (cut through the vein), not enough tension on skin (vein rolling), attempting while in a hurry, lack of confidence/experience
58
flow rate complications
venous pressure, vein spasms, phlebitit/thrombi, fluid viscosity, tubing occlusions, needle or gauge size, needle/cannula position, infiltration, height of fluid container, not enough fluid in bag
59
complications at IV site
pain and irritation, infiltration and extravasation, phlebitis, thrombosis and thrombophlebitis, hematoma formation, venous spasm, vessel collapse, cellulitis, and nerve, tendon, ligament, and limb damage
60
causes of infiltration
dislodgement of catheter, puncture of distal vein wall, poorly secured IV, poor vein or site selection, irritating solution or medication, improper cannula size, high delivery rate or pressure of the solution or medication
61
infiltration signs & symptoms
coolness of skin around IV site, swelling at the IV site (with or without pain), sluggish or absent flow rate, infusion continues to infuse when pressure is applied to the vein above the tip of the cannula, no backflow of blood into IV tubing when clamp fully opened and solution container lowered below IV site
discontinue IV, confirm catheter is intact, re-start IV away from the site, ice-pack if needed, document incident
62
IV complications - hematoma
when blood collects outside of the vessel after the catheter passes through the vein.
S/S: redness, tenderness, pain, swelling
remove catheter, confirm intact, apply light direct pressure to site, cover, document
63
IV complications - phlebitis
inflammation of the vein caused by injury to the vessel wall
S/S: pain, swelling, redness, tenderness
use an appropriate size catheter to cannulate the vein
64
IV complications - local infection
infection only present at or around the IV site. present after the IV cannulation.
S/S: (3-4 days after cannulation) redness, foul odour or discharge at the site
ensure site is clean and catheters and tubing are sterile when placing an IV
65
systemic IV complications
contamination and infection, hypersensitivity reactions, sepsis, emboli (blood clot, air, and catheter)
66
Air embolism from IV cannulation
caused by air entering the bloodstream via the catheter tubing. risk is greatest when a catheter is entered into central circulation where negative pressure may pull air in. if enough air enters the heart chamber, it can impede the flow of blood
S/S: hypotension, cyanosis, weak and rapid pulse, loss of consciousness
67
Air embolism management
close the tubing, turn pt on left side with head down, check tubing for leaks, administer high-concentration oxygen, call base hospital
68
mechanical complications of IVs
changes in the position of needle, height of solution, amount of solution, position of pt- kinked tubes, disconnected tubes, plugged air vents &/or plugged needles/cannula
69
flow rate (gtts/min)
volume (mls)/minutes x drop factor (gtts/min)
70
reporting IVs to hospital staff
location of IV, size of catheter, flow rate, how much fluid pt has received, any problems encountered
71
IV ACR documentation
time of insertion/attempt, number of attempts, size/catheter, vein selected/location, description of site/infusing abilities, paramedic information, reaction to IV, if you had to D/C it; time, condition of catheter
72
dose
the amount of drug the pt needs based on: weight, standard adult/peds dose, or units
73
volume
the amount of liquid that contains the required dose
74
syringe formula
desired dose/dose on hand x volume on hand
DD/DH x VH
75
infusion formula
volume to be infused(ml)/time(mins) x drop factor (gtts/ml)
VTBI/mins x gtts/ml
can break it down to per hour (can make 3000mls/180 mins into 1000mls/60 mins
76
conc. ratio from % solution
take % and put it into grams per 100mls
then put it into mg/100mls
move decimal place over by 2 on both sides
will give you the answer in mg/1ml which is your conc. ratio
77
conc. ratio from serial dilution
put ratio into 1g/x (mls)
divide both sides by number of mls
will leave you with mg/1ml
78
serial dilution from conc. ratio
divide 1000 by how many mg/1ml
79
serial dilution from % solution
must do conc. ratio from % solution first
80
% solution from conc. ratio
move decimals over twice to make it mg/100mls
convert to g/100mls
divide # of grams by 100mls
will leave you with the %
81
% solution from serial dilution
put ratio into g/ml
move decimal over until the right side is 100mls
move the other side over the same amount of times
will leave you with the %
82
left side of heart
thicker wall, mitral valve, pumps into systemic circulation via aorta & great vessels, receives blood from pulmonary veins, ventricles innervated by 2 fascicles of LBB
83
right side of heart
thinner wall, tricuspid valve, pumps into pulmonary circulation via pulmonary arteries, receives blood from inf. & superior vena cava, ventricle innervated with RBB, no fascicles, SA & AV node located in right atrium, coronary veins empty into right atrium
84
blood flow through heart
superior/inferior vena cava
right atrium
tricuspid valve
right ventricle
pulmonary veins
lungs
pulmonary arteries
left atrium
bicuspid valve
left ventricle
aorta
body
85
layers of heart tissue
epicardium (visceral pericardium)
myocardium (muscle bulk of heart)
endocardium (thin layer of endothelium)
pericardial sac (serous & fibrous layer)
86
cardiac cell properties
contractility (ability to contract)
excitability (ability to respond)
automaticity (ability to initiate)
conductivity (ability to propragate)
87
electrical pathway through heart
SA node
AV node
bundle of his
LBB/RBB
purkinje fibres
88
action potential
a change in membrane potential in an excitable tissue that acts as a electrical signal is propagated in all or none fashions
89
phase 4 cardiac cycle
resting phase - potential
inside of the cell is negative with respect to the outside
K+ is in Na+ is out
90
phase 0 cardiac cycle
rapid depolarization
membrane reachs threshold potential & voltage gated fast channel Na+ gates open
as increased permeability to Na+ exceeds permeability to K+ the membrane reaches the equilibrium potential
the inside of the cell becomes positively charged compared to the outside
91
phase 1 cardiac cycle
rapid depolarization
some chloride ions enter the cell and cause inactivation of fast Na+ channels
K+ continues to be lost from the cell
this causes a decrease in the number of positive electrical charges inside the cell and a drop in the membrane potential
92
phase 2 cardiac cycle
the plateau
voltage gated Ca++ channels open causing the slow influx of Ca++ into the cell
contraction of the muscle occurs
K+ continues to leave the cell slowly
the slow inward movement of Ca++ and slow outward movement of K+ keep the membrane in a prolonged state of depolarization which allows for the completion of muscle contraction
93
phase 3 cardiac cycle
end of rapid repolarization
Ca++ channels close
K+ gates open resulting in an outward movement which leads to membrane repolarization
eventually K+ channels close
the Na+ K+ ATPase pump restores the membrane to its resting potential of phase 4
94
cardiac output
relies on heart rate and stroke volume
CO = HR x SV
BP = CO x SVR
95
factors affecting preload
decreasing volume - hemmorrhage, burns
increased heart rate - decreases LV filling time
decreased LV stretch - ischemia, necrosis
96
factors affecting afterload
increased sympathetic tone - increased aortic pressure
increased vascular tone - increased resistance
97
ECG paper/speed
box is 10mm high and 0.20 sec wide
98
determining heart rate by boxes
count between two QRSs on thick lines
300, 150, 100, 75, 60, 50,
99
p wave
represents depolarization of the artia
100
QRS segment
represents ventricular depolarization
101
T wave
repolarization of the ventricle
102
absolute refractory period
no electrical current gets through no matter what
103
relative refractory period
only a very strong current can get through
104
approach to 3 lead interpretation
rate - fast/slow
rhythm - regular/irregular
p wave - present/absent/inverted/retrograde
P:QRS ratio - does every P have a QRS?
intervals - PR, QRS
groupings
dropped beats
105
sinus rhythm
rate - 60-100bpm
rhythm - regular
p wave - normal, present
P:QRS ratio - 1:1
PR interval - normal
QRS width - normal, narrow
dropped beats - none
grouping - none
106
sinus tachycardia
rate - >100bpm
rhythm - regular
p wave - normal
P:QRS ratio - 1:1
PR interval - normal to slightly shortened
QRS width - normal to slightly shortened
dropped beats - none
groupings - none
107
sinus bradycardia
rate - <60 bpm
rhythm - regular
p wave - normal
P:QRS ratio - 1:1
PR interval - normal to slightly prolonged
QRS width - normal to slightly prolonged
dropped beats - none
grouping - none
108
sinus arrhythmia
rate - 60-100bpm
rhythm - irregular
p wave - normal
P:QRS ratio - 1:1
PR interval - normal
QRS width - normal
dropped beats - none
grouping - none
109
sinus pause/arrest
rate - normal to slow
rhythm - irregular
p wave - normal
P:QRS ratio - interupted by dropped beats
PR interval - normal
QRS width - normal
dropped beats - yes
grouping - none
110
NSR with PAC
rate - depends on underlying NS rate
rhythm - irregular
P wave - varies in the PAC, otherwise normal
P:QRS ratio - 1:1
PR interval - varies in the PAC, otherwise normal
QRS width - normal
dropped beats - none
grouping - sometimes
111
PVC
rate - depends on underlying rhythm
rhythm - irregular
p wave - not present in PVC
P:QRS ratio - not present in PVC
PR interval - none
QRS width - wide (>0.11) bizarre
dropped beats - none
grouping - sometimes
112
atrial fibrillation
rate - variable (variable ventricular response)
rhythm - irregularly irregular
p wave - none
P:QRS ratio - none
PR interval - none
QRS width - normal
dropped beats - none
grouping - none
113
atrial flutter
rate - atria 250-350 bpm, ventricle 125-175 bpm
rhythm - usually regular, but can be variable
p wave - saw tooth appearance
P:QRS ratio - variable, most common 2:1
PR interval - variable
QRS width - normal
dropped beats - none
grouping - none
114
junctional rhythm
rate - 40-60 bpm (normal) or >100bpm (junctional tachycardia)
rhythm - regular
p wave - variable
P:QRS ratio - none, 1:1 if antegrade
PR interval - none, short or antegrade
QRS width - normal
dropped beats - none
grouping - none
115
1st degree AV block
rate - depends on underlying rhythm
rhythm - regular
p wave - normal
P:QRS ratio - normal
PR interval - prolonged, >0.20s
QRS width - normal
dropped beats - none
grouping - none
116
2nd degree AV block Mobitz type 1
rate - depends on underlying rhythm
rhythm - regularly irregular
p wave - present
P:QRS ratio - variable
PR interval - variable
QRS width - normal
dropped beats - yes
grouping - present and variable
progressive lengthing of PR interval before a beat is dropped
117
2nd degree AV block type 2
rate - depends on underlying rhythm
rhythm - regularly irregular
p wave - normal
P:QRS ratio - variable
PR interval - normal
QRS width - normal
dropped beats - yes
grouping - present and variable
constant PR interval before dropped beat
118
3rd degree AV block
rate - seperate rates (underlying sinus & escape)
rhythm - regular (P&QRS rate differ)
p wave - present
P:QRS ratio - variable
PR interval - variable, no pattern
QRS width - normal to wide
dropped beats - none
grouping - none
no communication between artia and ventricles, beat seperately
119
indoventricular
rate - 20-40bpm (regular) 60-100bpm (accelerated indoventricular)
rhythm - regular
p wave - none
P:QRS ratio - none
PR interval - none
QRS width - wide and bizarre
dropped beats - none
grouping - none
120
ventricular tachycardia
rate - 200-300 bpm
rhythm - regular
p wave - none
P:QRS ratio - none
PR interval - none
QRS width - wide and bizarre
dropped beats - none
grouping - none
121
ventricular fibrillation
rate- indeterminate
rhythm - chaotic
p wave - none
P:QRS ratio - none
PR interval - none
QRS width - none
dropped beats - none
grouping - none
122
torsades de pointe
rate - 200-250 bpm
rhythm - irregular
p wave - none
P:QRS ratio - none
PR interval - none
QRS width - variable
dropped beats - none
grouping - variable sinusoidal pattern
123
LBBB
wide QRS, dominant S wave in V1, broad monophasic R wave in lateral leads (I, aVL, V5-V6)
W in V1, bunny ears (M) in V6
124
RBBB
wide QRS, RSR pattern in V1-V3, wide slurred S wave in lateral leads (I, aVL, V5-V6) M in V1, W in V6
125
hyperkalemia
begins with peaked T waves, P wave eventually flattens out & dissapears, QRS widens out indicating delayed ventricular depolarization
126
pericarditis
diffuse ST elevation, benign morphology, PR depression. stabbing burning pain, worse with laying flat, persitant and prolonged
127
causes of cardiac arrest
80% caused by atherosclerosis or underlying cardiac issues, also caused by genetic disorders, cardiomyopathies, drug overdoses, trauma, drowning, electrocution
128
reasons to prioritize an advanced airway
vomiting or airway secretions, prolonged extrication or resuscitaton, poor seal with OPA/BVM
129
pulse checks
every 2 minutes, last 15 seconds should be used to landmark pulse with CPR, then check for pulse without CPR. can also be done if there are obvious signs of life
130
shockable rhythms
V-fibb (course or fine), V-tach
131
non shockable rhythms
asystole, PEA
132
ETCO2 in cardiac arrest
used to: verify airway placement/identify displacement, evaluate CPR quality, identify ROSC, determine when ROSC is unlikely
133
higher ETCO2 in cardiac arrest
good quality CPR, high cardiac output, good ventilations. high jump can indicate ROSC. levels >25mmHg at the 20 minute mark are associated with survival
134
lower ETCO2 in cardiac arrest
must improve CPR quality or change compressors. decreasing levels indicate compressor fatigue, hyperventilation, airway obstruction, or airway displacement. levels <10mmHg at the 20 minute mark are associated with futility (except in hypothermia)
135
signs of ROSC
sudden rise in ETCO2, spontaneous respirations, palpable pulses, change in colour, spontaneous movement
136
ROSC care
titrate oxygenation between 94-98%, avoid hyperventilation - ETCO2 between 30-40mmHg, IV bolus if hypotensive, 12 lead ECG. if any spontaneous breathing elevate pt's head by 30degrees to take some pressure of their chest and make breathing easier
137
DNR
establish presence ASAP, can be honoured without BHP if valid, if incomplete/not present consult BHP
138
PD at VSA
manage spectators, protect scene, notify family MD if TOR'd, notify coroner, connect family with victims services, must be updated on moving the body and transport location
139
FD at VSA
assist with pt care, can accompany to ED if needed
140
re arrest enroute after ROSC
resume CPR, pull over, initiate immediate rhythm interpretation, treat accordingly, continue transport to ED
run arrest enroute to ED. ensure rhythm analyses and defibrillation can be done safely while enroute
141
when won't you run a medical arrest for 20 minutes
any "primary clinical considerations", refractory V-Fibb/V-Tach (leave after 3 consecutive shocks), ROSC, extenuating circumstances listed in MD
142
first 2 minutes, cardiac arrest
get the story/determine cause, check for DNR, apply cardiac monitor, move pt to workable spot if necessary
143
20 minute mark, cardiac arrest
TOR or transport
144
adult joule settings
zoll - 120J, 150J, 200J
lifepack - 200J, 300J, 360J
145
pediatric joule settings
2J/kg, 4J/kg
146
pregnant VSA
presumed to be >20 weeks gestation. run like regular arrest. consider very early transport - after 1 analysis and egress plan organized. run arrest enroute, transport to closest ER. TOR contraindicated
147
hypothermic VSA
must believe VSA is secondary to hypothermia. remove pt from cold enviroment even if it delays resus, document why. focus on passive rewarming and gentle handling, rough movement can cause lethal arrhythmias.
consider very early transport - after 1 analysis and egress plan organized. run arrest enroute, transport to closest ER. TOR contraindicated
148
VSA - airway obstruction
high instances in children. do 3-5 minutes of high quaility CPR before worrying about airway. if after 5 minutes the obstruction hasn't come up, use OPA/BVM to push in down so you can ventilate at least 1 lung. when airway is cleared run as normal cardiac arrest. consider very early transport - after 1 analysis and egress plan organized. run arrest enroute, transport to closest ER. TOR contraindicated
149
VSA - non-opioid drug/toxicology
try and determine what the substance was and how much was ingested. consider very early transport - after 1 analysis and egress plan organized. run arrest enroute, transport to closest ER. TOR contraindicated
150
I-Gel sizing
1 - neonate - 2-5kg
1.5 - infant - 5-12kg
2 - small pediatric - 10-25kg
2.5 - large pediatric - 25-35kg
3 - small adult - 30-60kg
4 - medium adult - 50-90kg
5 - large adult - 90+kg
151
I-Gel complications
trauma to the pharyngo-laryngeal framework, down-folding of the epiglottis (more common in children), gastric insufflation, regurgitation, and inhalation of gastric contents, nerve injuries, vocal cord paralysis, lingual or hypoglossal nerve injuries, if too high in the pharynx - poor seal and excessive leakage, laryngospasm
152
respiration
the process by which oxygen and carbon dioxide diffuse in and out of the blood. also referred to as gas exchange
153
external respiration
gas exchange across the respiratory membrane in the lungs
154
internal respiration
gas exchange across the respiratory membrane in the metabolizing tissues such as skeletal muscles
155
pulmonary ventilation
the process by which oxygen enters and carbon dioxide exits the alveoli. the act or process of inhaling and exhaling
156
oxygenation
the process of adding oxygen to the body system. how oxygen gets to the tissues
157
SPO2
saturation of peripheral capillary oxygenation. measures % of oxygen bound to red blood cells. non invasive monitoring but changes can take minutes to be detected. can also have signinficant artifact secondary to movement, circulation, and nail polish
158
ETCO2
measures ventilation status, the amount of CO2 in the airway at the end of exhalation. provides reading for every breath so results are in seconds. non invasive monitoring, not affected by motion or circulation sensitive and specific
159
dead air space
ventilated areas that do not participate in gas exhange. V/Q ratio is high
160
shunt
blood flows through the lungs but is not oxygenated because the lungs and the alevoli are not ventilated. V/Q ratio is very low
161
why is capnography important
respiration, ventilation, and oxygenation are very different. verifies proper airway placement.
162
what is capnography
represents the amount of CO2 in exhaled air.
163
capnometry (actual number)
partial pressure of CO2 at the end of exhalation
164
high ETCO2
> 45mmHg, holding on to too much CO2. hypoventilation, hypercapnia,
165
low ETCO2
<35mmHg, blowing off too much CO2, hyperventilation, hypocapnia
166
quantitative vs qualitative ETCO2 monitoring
quantitative: an actual numeric value. usually associated with an electronic device
qualitative: normally give a range could say low/medium/high or will give just a colour
167
PACO2
partial pressure of carbon dioxide in artieral blood gases. measured by drawing blood. if ventilation and perfusion are stable, PACO2 and PETCO2 should be the same
168
the waveform (capnography)
capnogram waveform begins before exhalation and ends with inspiration.
phase 1 - (A-B) inspiratory baseline (low CO2 as its inspired air)
phase 2 - (B-C) exhalation upstroke (dead space gas mixes with lung gas)
phase 3 - (C-D) continuation of exhalation (gas is all alveolar now, rich in CO2)
phase 4 - (D-E) start of inspiration
D is the end tidal value, peak concentration
169
sudden loss of waveform
ET tube disconnected, dislodged, kinked or obstructed, loss of circulatory function
170
decreasing ETCO2
ET tube cuff leak, ET tube in hypopharynx, partial obstruction
171
sudden increase in ETCO2
can indicate ROSC. large amounts of acidic blood are suddenly returned to the lungs and high amounts of CO2 diffuse into the alveoli. this flood causes a sharp rise in ETCO2 to levels much higher than normal
172
shark-fin apperance
bronchospasm, asthma, copd. caused by air being delayed by the bronchospasm. the rise to the plateau is more gradual and the plateau itself becomes sloped
173
hyperventilation
low ETCO2, blowing off too much CO2 due to increased rate of breathing. can be caused by anxiety, bronchospasm, pulmonary embolus, hypotension, decreased cardiac output, cardiac arrest
174
hypoventilation
high ETCO2, retaining too much CO2 due to a slow rate of breathing. can be caused by overdose, sedation, intoxication, postictal states, head trauma, stroke, tiring CHF, fever sepsis, SOB
175
ETCO2 and cardiac output
when cardiac output is normal, ETCO2 measures ventilation. when cardiac output is decreased, ETCO2 measures cardiac output. when decreased, they won't have a normal PACO2 to ETCO2 ratio
176
ETCO2 in cardiac arrest
capnography provides feedback on the quality of CPR. if <10mmHg compressions are not deep or fast enough. when circulation is restored a spike in ETCO2 occurs. even if you can't feel a pulse, circulation must be present for this spike to occur. <10mmHg also indicates pt will not survive.
177
stubbornly low ETCO2 in cardiac arrest
if a pt has been VSA for a long time, vasodilation and sluggish blood flow prevents the build up of significant cardiac output despite quality CPR and a properly secured airway.
178
DOPES
displacement - airway has been dislodged
obstruction - airway has been blocked by mucus, blood, vomit, or kinking.
pneumothorax - sudden decreases in breath sounds on 1 side, increased airway pressure
equipment failure - check O2 supply, BVM tubing, connections
stacked breaths/stomach - inadequate exhalation time, air trapping, increased intrathoracic pressure
179
gastric port suctioning advantages
minimally invasive, easy, suctions secretions that affect positioning of SGA
180
gastric port suctioning limitations
cannot remove foreign bodies or thick emesis, will not solve active vomiting or vomit in the airway
181
rhythms treated under tachydysrhythmia MD
must originate above AV node, must check if rhythm is regular or irregular and if QRS is wide or narrow. PCP's only treat narrow, regular rhythms. must do a 12 lead before treatment
182
confirming SVT
heart rate >150bpm? regular rhythm? abnormally short or nonexistant PR interval? QRS complex narrow?
183
SVT rhythms not treated with valsalva
sinus tach, a-fibb with RvR, atrial flutter, junctional tach, multi atrial tach
184
SVT S/S
sudden onset of rapid regular palpitations, syncope/pre-syncope, chest pain, dyspnea, anxiety, 140-280bpm
185
how does modified valsalva work
tricks body into parasympathetic response by building intrathoracic pressure
186
potential adverse effcts of valsalva
lightheadedness/syncope, nausea/vomiting, chest pain, rupture of the round window of the ear
187
lateral patella dislocation risk factors
12-20 yr olds, females as wider pelvis structure can cause imbalances, unbalanced or underdeveloped MSK system, knock knees (knees tilted inwards), patella alta (high riding patella on femur), underdeveloped patellas, generalized joint laxity, knee hyperextension
188
patella dislocation differentials
knee dislocation, quadricep tendon ruptures, patella fractures
189
refractory VF or pulseless VT
persistent VF or pulseless VT after 3 consectutive shocks
190
Define **angina**.
A type of chest pain caused by reduced blood flow to the heart.
191
What is a common symptom of **CHF**?
Shortness of breath, fatigue, and fluid retention.
192
Define **myocardial infarction**.
Damage to heart muscle due to lack of blood supply.
193
What is the primary cause of **angina**?
Reduced blood flow to the heart muscle.
194
What is a major risk factor for **heart disease**?
High blood pressure, high cholesterol, and smoking.
195
Define **arrhythmia**.
An irregular heartbeat that can affect blood flow.
196
What is a common treatment for **angina**?
Nitroglycerin to relieve chest pain.
197
What is a common symptom of **myocardial infarction**?
Chest pain or discomfort, often radiating to the arm.
198
What is the role of **cholesterol** in heart disease?
High levels can lead to plaque buildup in arteries.
199
Define **pericarditis**.
Inflammation of the pericardium, the heart's outer layer.
200
Define **cardiomyopathy**.
A disease of the heart muscle affecting its size and shape.
201
Define **COPD**.
Chronic Obstructive Pulmonary Disease, a progressive lung disease that obstructs airflow.
202
What is **emphysema**?
A type of COPD characterized by damage to the alveoli, leading to breathlessness.
203
What triggers **asthma** symptoms?
Common triggers include allergens, smoke, exercise, and respiratory infections.
204
Define **pulmonary fibrosis**.
A lung disease that occurs when lung tissue becomes damaged and scarred.
205
What is the **main symptom** of COPD?
The main symptom is shortness of breath, especially during physical activities.
206
What is the **primary treatment** for COPD?
The primary treatment includes bronchodilators and corticosteroids.
207
Fill in the blank: **Emphysema** primarily affects the _______ in the lungs.
alveoli
208
Define **chronic cough**.
A cough that lasts for eight weeks or longer, often associated with respiratory diseases.
209
What is **interstitial lung disease**?
A group of disorders that cause scarring of lung tissue, affecting breathing.
210
Define **pneumonia**.
An infection that inflames the air sacs in one or both lungs.
211
True or false: **Corticosteroids** can reduce inflammation in asthma.
TRUE
## Footnote
They are often used as a long-term control medication.
212
Define **chronic obstructive asthma**.
A form of asthma that leads to persistent airflow limitation.
Year 2
flashcards
Decks in class (6)
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