Mid-Term Flashcards

Question

S/S of PTSD?

Answer 1

-Nightmares -Irritability -Insomnia -Inability to think clearly or concentrate -Flashbacks -Increased interpersonal conflicts -decreased ability relate to others

Answer 2

The result of constant exposure to stressful situations that build over time *Note that cumulative stress disorder is the most common cause of burnout; a state of irritability and exhaustion

Answer 3

- irritability with coworkers, family and friends - inability to concentrate - difficulty sleeping and nightmares - anxiety - indecisiveness - guilt - loss of appetite - loss of sexual desire or interest - isolation - loss of interest in work

Answer 4

-Thinking: Confusion, inability to make judgments or decisions, loss of motivation, chronic forgetfulness, and loss of objectivity -Physiological: Depression, excessive anger, negativity, hostility, defensiveness, mood swings and feelings of worthlessness -Physical: persistent exhaustion, headaches, gastrointestinal distress, dizziness and pounding heart -Behavioral: over-eating, increased alcohol or drug use, grinding teeth, hyperactivity and lack of energy -Soical: increased Interpersonal conflicts and decreased ability to relate to patients as individuals

Answer 5

Identified by state laws, scope of practice are the actions and care that EMTs are legally allowed to perform in their state. Scope of Practice begs the question: Was the EMT allowed by law to do what he did? scope of practice identifies which activities would be deemed illegal if performed without licensure or certification and establishes boundaries among professionals. *You should never perform a skill you know how to perform if it is outside your scope of practice

Answer 6

- national highway traffic safety administration (NHTSA) - national EMS scope of practice model - national EMS education standards

Answer 7

The care that is expected to be provided by an EMT with similar training when managing a patient in a similar situation

Answer 8

1) did the EMT provide the right assessment and emergency care for the patient? 2) did the EMT perform the assessment and emergency care properly

Answer 9

- recognized and accepted EMT textbooks - the care that would be expected by other EMT's in the community or region. - local and state protocols - NHTSA's national EMS education standards - the EMS systems operating policies and procedures

Answer 10

Your legal obligation to provide service, whether you think the patient needs it or not

Answer 11

- stop and help the victim. (Doing this will create a duty to act. others may not respond to the call because they feel that your response is adequate. You assume certain legal responsibilities and you cannot leave until someone with the appropriate expertise takes over.) - pass the scene and call for help - pass the scene and make no attempt to call for help * this is not true for all states as some of them do require you to act even when you are off duty *Also note, that one of your most important aspects of your duty to your patient is respecting the rights of the patient. You must serve as the patient's advocate, protect and honor their rights, which includes the confidentiality of the patient's medical status, history and records. You must also act to lessen the patient's suffering and provide complete and competent care for your patient which includes emotional care beyond treating their injury.

Answer 12

-A duty to yourself -A duty to your partner -A duty to your equipment

Answer 13

-obtain the necessary credentials to practice as an EMT -maintainace of your skills to a good level of proficiency -maintainance of your mental health -maintainace of your physically fit body to be able to perform the duties of the job

Answer 14

- ensuring that he or she is physically and mentally fit to provide proper care and take the responsibility of the job - you must be a snitch if you find your partner under the influence of alcohol or drugs

Answer 15

- ensure that all equipment is in proper working order (done at the beginning of each shift) *its negligence if you can't treat a patient due to faulty equipment

Answer 16

It protects a person who is not being paid for his services from liability for acts performed in good faith unless those acts constitute gross negligence. *The good Samaritan law does not protect you from being sued so always render care to the best of your ability

Answer 17

Also known as governmental immunity, prevents persons treated by governmentally operated EMS systems from suing the government for civil liability. *This is a type of immunity private EMS companies DO NOT have.

Answer 18

This means the patient only has a certain amount of time to file a negligence claim.

Answer 19

If a patient contributes in any manner to his own injury or illness and tries to file a negligence claim against an EMS provider, they could be found GUILTY!!

Answer 20

-follow standing orders and protocols, as approved by medical direction -establish cell phone, video chat, telephone, and radio communications with medical direction when appropriate -communicate clearly and completely with medical direction, and follow orders medical direction gives in response -Any time there is a question about the scope or direction of care, consult medical direction

Answer 21

When the conscious patient who has the capacity to understand and make an informed and rational decision agrees to the care once they are informed of the care to be provided and the necessary risks and consequences. *Note that you cannot gain a patient's consent purely because they called 911

Answer 22

When an conscious adult who has the capacity to make a rational decision before treatment is started gives consent either spoken or through non-verbal cues such as nodding *Document everything, even the form of non-verbal cues they used

Answer 23

Also known as the emergency doctrine, occurs when you assume the patient who is unresponsive or who is unable to make a rational decision would consent to emergency care if they could. for example, a head injury.

Answer 24

Consent to treat a minor must be obtained from a parent, legal guardian, or others with permission. This is because minors are not considered legally competent to accept or refuse medical care. *Minors are considered those under 18 in some states but under 21 in others

Answer 25

You apply the concept of implied consent, assuming the parent would consent to treat their child if they were there. *document situation and why you treated even though the parent was not present

Answer 26

Emancipated minors. this is when they are married, pregnant, a parent, a member of the armed forces, financially independent and living away from home, or one who has been declared emancipated by court decree.

Answer 27

Applied when you are dealing with an mentally incompetent adult or with an individual who is in custody of law enforcement or is incarcerated. *often involves a 3rd party such as a legal guardian or an officer from which you must gain the consent from said 3rd party since they must make the decision on their behalf because the individual does not have the legal right to determine their own care.

Answer 28

An action knowingly committed by an individual that is considered civilly wrong according to the law *common intentional torts within the EMS system include abandonment, assault, battery, false imprisonment, and defamation.

Answer 29

negligence is a failure to meet the standard of care which is typically permissible, whereas an intentional tort is knowingly committed.

Answer 30

When you stop treatment of the patient without transferring the care to another competent professional of an equal or higher level of training and certification or licensure *ensure you OFFICALLY transfer the patient into the care of someone competent before you leave. Oral report to a physician, nurse, or other health care worker who is qualified. For example, you can't leave the patient with a unit clerk or with a dermatologist if they are a mutisystem trauma patient. *There are exceptions to this rule. an paramedic or an AEMT can transfer the patient to an EMT as long as the injuries or condition of the patient can be managed by the EMT and no advanced life support skills are needed

Answer 31

Assault is a willful threat to inflict harm on a patient Battery is the act of touching a patient unlawfully without their consent

Answer 32

When you transported a patient who has the capacity to understand and make rational decisions even though they refused treatment

Answer 33

When you release information to the public in either a written (Libel) or spoken form (Slander) that is construed to be damaging to the person's character , reputation or standing within the community

Answer 34

When you effectively communicate/document the patient's condition, you give the receiving facility the best idea of what to do, which obtains the highest quality patient care.

Answer 35

The documentation you provide typically becomes a part of the patient's permanent hospital record. It is used to prepare bills and for submitting records to insurance companies. The information may also be used for statistics regarding the emergency medical service itself such as average response time on scene, time on scene for critical trauma patients, or the number of cardiac arrests patients treated each year.

Answer 36

A run in which you were involved may have been the result of a crime or the incident may have led to a civil lawsuit. In either case, you may have to appear in court. As such, you will refer your documentation. Ensure that your documentation is legible , accurate and complete. include objective and pertinent subjective findings, the status of the patient upon arrival, what emergency care was provided, when the emergency care. etc... Be very detailed and thorough.

Answer 37

Your documentation provides data for researchers studying a whole range of issues. The PCR may be used to track or identify various patient presentations and conditions that may require additional education and training. For example , some scientists and researchers may be looking to discover positive or negative effects of certain interventions at different stages of patients contact.

Answer 38

Reviews of documentation are an integral part of the quality improvement process. Remedial courses for EMT's may be based on weaknesses on the documentation. PCRs are also used in medical oversight to determine if EMTs are adhearing to protocols and set standard of care.

Answer 39

-continuity of medical care -administrative use -legal documentation -educational and research use -evaluation and Continuous quality Improvement (CQI)

Answer 40

The set of data, the Department Of Transportation (DOT) recommends including on all PCRs. An attempt on standardization on PCRs. *Time synchronization is so important when establishing the Minimum Data Set because it helps to gather accurate medical information. Dispatch and medical personnel should have the same time set on their clocks. It helps determine important information such as how long it really was before CPR or defibrillation was initiated in a cardiac arrest patient.

Answer 41

- chief complaint - level of responsiveness (AVPU)-Mental status - blood pressure for patients greater than 3 years old - skin perfusion (capillary refill) for patients less than six years old - skin color, temperature and condition - pulse rate - respiratory rate and effort - patient demographics (age, sex, race, and weight)

Answer 42

- time the incident was reported - time the unit was notified - time of arrival at the patient - time the unit left the scene - time the unit arrived at its destination (hospital, etc...) - time of transfer of care

Answer 43

1. Draw a single horizontal line through the error (preferably using different colored ink) 2. Add a note with the correct information beside it 3. Initial the entry 4. Include the time and date of the correction, if you ALREADY submitted the report *DO NOT ERASE OR WRITE OVER THE MISTAKE. This could be seen as an attempt to cover up a mistake or falsify the report. *Whenever you correct a PCR, make sure you notify the personnel to whom you submitted the incorrect form to that you made an error and corrected it

Answer 44

1. Add a note with the correction information 2. Add the date 3. Add your initials

Answer 45

Most electronic PCR formats provide a method to amend the report that includes a date and time stamp If an error is discovered. If there is no way to electronically amend or submit an emended report, correct a printed copy using the traditional methods described for a paper report and resubmit PCR as it corrected copy.

Answer 46

-licences individual base station operations -assigns radio call signs -approves equipment for use -establishes limitations for transmitter power output -assigns radio frequencies -monitors field operations *Not a responsibility but the FCC has also set regulations to limit interference with radio broadcasts and to bar the use of obscenity and profanity in broadcasts

Answer 47

-obtain as much info as possible about an emergency -to direct the appropriate emergency services to the scene -to advise the caller how to manage the situation until help arrives

Answer 48

AACN is found as a standard feature in many newer car models. Not only can this technology accurately indicate that's the vehicle was involved in a crash, but it can also provide the exact location of the vehicle and indicate change in velocity during the crash, direction of force, airbag deployment, rollover and occurrence of multiple collisions *According to the 2009 Centers for Diease Control and Prevention Guidelines for Field Triage of Injured patients, AACN can be used to: predict injury severity, determine transportation mode (air v ground), and determine medical facility destination (level of trauma center)

Answer 49

1. To acknowledge that the dispatch call information was received 2. To advise dispatch when the unit is en route to the call 3. To estimate your time of arrival at the scene while en route and to report any special road conditions, unusual delays, etc... 4. To announce your unit's arrival on the scene, request any additional resources and to help coordinate the response. (Some systems require you call dispatch when you reach the patient) 5. To announce the unit's departure from the scene and to announce the destination hospital, number of patients transported and estimated time of arrival at the hospital. 6. To announce your arrival at the receiving hospital or other facility. (Or announce arrival at rendezvous point if one is set) 7. To announce that you are clear and available for another assignment after the patient has been transferred 8. To announce that you are leaving the hospital and on your way back to the station 9. To announce your arrival back at the station *dispatch should be contacted if there is a prolonged on scene time without contact *Note that dispatch records all conversations with initial callers , police, fire personnel, EMT units and receiving facilities. The calls can become a part of a court case. Be professional, concise, and accurate when communicating with dispatch. *Note that dispatch will give you the time after most communications with you. This helps in providing accurate time in your PCR.

Answer 50

-Posture -Distance -Gestures -Eye contact -Haptics

Answer 51

-Approach the patient with open arms, open hands and relaxed shoulders. This conveys a message of concern. - position yourself at the same level as your patient to indicate that you see the patient as a equal *if the patient is uncomfortable, it can limit communication

Answer 52

In american culture , the space within less than 1½ feet of an individual is called the intimate zone. Entering your patients intimate zone may be perceived as threatening. It is best to use a more personal distance of about 1 to 4 feet from your patient when you are communicating with them. You can get close in order to do hands-on/assess them BUT ask and inform your patient about what you need to do before you enter their personal space. Most patients understand the need to enter their intimate zone but those who resist, step back until you establish trust. *NOTE that not every culture abides by American standards with their spatial zones so misunderstandings may occur. consider a patient's culture and nonverbal responses when invading their personal space. *note that 4-12 feet is the appropriate distance to talk to another person without shouting

Answer 53

Nonverbal body movements that convey meaning to others. For example, winking , smiling, rolling your eyes, pushing your eyebrows together or any other expression that conveys an emotion. (Not exclusive to facial expressions but could be from any body part) *You should maintain a warm, kind smile indicates your concern and welcomes communication from your patient. *also watch your patients Gestures to see what they are indicating such as anxiety, pain, sorrow, relief, or dismay

Answer 54

Make and maintain eye contact when you are speaking to the patient to communicate your interest and concern * BE AWARE THAT SOME CULTURES CONSIDER DIRECT EYE CONTACT INPOLITE OR AGGRESSIVE. you may need to adjust your behavior.

Answer 55

Touch can be one of the most effective ways to help calm the patient and express your compassionate and empathy. - holding a hand, patting a shoulder , giving a hug or laying your hand on the forearm * a patient's age, gender, culture and experience may influence how non-verbal communication is interpreted, such as touch. Ask for permission if you sense reluctance

Answer 56

You MUST move them first but follow local protocol to ensure you do not become a additional causality

Answer 57

When there is immediate danger to the patient or to the rescuer *In a an unstable or threatening environment, your priority is to move the patient (not ABC's or immediate life threats) if possible, but you have to follow local protocol to ensure you do not become an extra causality *NOTE that the greatest danger to a patient during an emergency move is spinal cord injury since it is impossible to move a patient quickly while still providing the best protection to the spine and spinal cord. Only perform a emergency move if it is your last option.

Answer 58

- immediate environmental danger (fire, exposure, explosives) -Inability to protect the patient (uncontrolled traffic, physically unstable surroundings, extreme weather conditions, and hostile bystanders) -Inability to provide life-saving care before of the patient's location or position (need to change a patient's position if controlling hemorrhage, to defibrillate, or to perform CPR)

Answer 59

1. armpit-forearm drag 2. shirt drag 3. blanket drag

Answer 60

1. Ensure the patient is on the floor 2. you can move him by inserting your hands under the patient's armpits from the back. 3. Grasp the patient's left forearm with your right hand and the right forearm with your left hand 4. drag

Answer 61

1. Fasten the patient's hands or wrists loosely together, if possible link them to a belt, pants with a small Velcro wrap or self adherent bandage , this will serve to prevent the patient's arms from flopping out of the shirt. 2. Grasp the neck and shoulders of the shirt so that the patient's head rest on your fist 3. Using the shirt as a handle, pull, the patient toward you.Be careful not to strangle the patient. * the shirt drag cannot be used if the patient is wearing only a t-shirt

Answer 62

1. Spread blanket alongside the patient. gather about half into lengthwise pleats (vertical folds) 2. Roll the patient away from you onto his side. Tuck the pleated part of the blanket as far beneath the patient as you can. 3. Roll the patient back onto the center of the blanket and onto his back. 4. Wrap the blanket securely around the patient 5. Grab the part of the blanket that is beneath the patient's head and drag the patient toward you

Answer 63

When the patient needs to be moved for immediate treatment and transport such as someone in a MVA or someone who requires CPR but they're on the couch *For example, indications for a urgent move using the extrication method includes but is not limited to: -Altered Mental Status -Inadequate respiratory rate or tidal volume -Indications of shock (AMS, pale, cool, clammy skin, tachycardia, and increased respiratory rate) -Injuries to the head, neck, chest, abdomen, and pelvis -Fracture of both femurs -Major bleeding

Answer 64

1. One rescuer should provide manual stabilization of the head/spine. 2. A second rescuer should apply a C-Collar as a third person places a long back board near the door (I think the driver side) the third rescuer should then move to the passenger seat. 3. The second rescuer should support the patient's thorax as the third frees the patient's legs from the pedals or from under the dashboard 4. The second and third rescuer rotate the patient. In several short, coordinated moves until the patient's back is in the open doorway, and his feet are on the seat 5. Since the first rescuer can no longer support the patient's head, another rescuer should support the head and so the first rescuer exits the vehicle and takes over supporting the head from the door opening 6. The end of the long backboard is placed on the seat next to the patient's buttocks. The first and second rescuers lower the patient onto it. The first maintaining inline stabilization of the head and neck 7. The second and third rescuers should then slide the patient into the proper position on the board. * The most critical factor is that this procedure must be accomplished rapidly and without any compromise to the patient's spine. *Also note that once the patient is extricated, they may (varies by local protocol) be moved off the backboard and placed on a vacuum mattress or on the stretcher. The backboard is used only as an extrication device and not for protecting the spine for further assessment *Rapid extrication should be done when there is abnormality to the the airway, breathing, circulation, oxygenation, and for those with critical injuries and illnesses.

Answer 65

1. Instruct the patient to keep his head and neck in a neutral line position. They should keep their nose in line with their umbilicus (naval) 2. Apply a rigid or soft cervical collar, more as a reminder to the patient to not move his head and neck then to provide stabilization itself 3. Instruct the patient to move his body as one unit 4. Instruct the patient to swing his legs out of the vehicle so the front of his body is facing outside the vehicle door 4. Instruct the patient to stand and move out of the vehicle 5. Constantly coach the patient to maintain a neutral in line position *NOTE self-extrication is done when you need access to a patient in the vehicle but someone is blocking them, if this someone is not critically injured, self extrication can be used *The two urgent moves are extrication and self-extrication

Answer 66

Also called an ambulance gurney or stretcher is the patient carrying device most commonly used by rescue personnel and it is also the safest and most comfortable means to transfer a patient up to 650 pounds. *Note in order to roll a wheeled stretcher, a rescuer at the head pushes and the rescuer at the foot guides *The lift in-type stretcher has been replaced with the role-in or self-loading stretcher, which weighs about 70-75 pounds and is constructed of aluminum alloy. The stretcher uses wheels at the head to simplify the loading and unloading procedure. This significantly reduces the amount of twisting and lifting required by rescuers.

Answer 67

The traditional manual stretcher: it requires the EMT's to do all the lifting to raise and lower and load and unload the stretcher from in and out of the back of the ambulance. The newer power stretcher: It uses pneumatic, hydraulic, battery (motor) or a combination of mechanics to reduce loading strain. Although these stretchers weigh more than traditional stretchers, up to 140 pounds, some has a power loading device that lifts and lowers the stretcher in and out of the ambulance.

Answer 68

-Rolling is usually restricted to smooth terrain. However, four rescuers, one at each corner can keep it stable and move it over rough ground. -two rescuers can carry a wheeled stretcher in a narrow space. However, they will need to face each other from opposite ends , the stretcher could be easily unbalanced and the lift and carry require considerable strength.

Answer 69

Stretchers that are designed to hold patients up to 1600 pounds in a wheels down position. They have larger wheels for stability, lighter stretcher dimensions and more heavily constructed frames. * Some stretchers are part of the bariatric transport system that includes an ambulance ramp and winch a specialized bariatric ambulance

Answer 70

Also known as a soft stretcher it has a loading capacity of 350 pounds and It is usually made of a continuous tubular metal frame canvas or coated fabric bottom and straps to secure the patient. It is used when the patient must be removed from a narrow space OR/AND it can also be used as an additional support to the wheeled stretcher when there is more than one patient to transport because it could be loaded easily into an ambulance and offloaded easily once in the ambulance. *Portable stretchers come in three models. The basic model, the basic with folding wheels, and the breakaway * most models can be hung inside the ambulance and it is a relatively light stretcher that can be folded in half

Answer 71

Pros: -It is lightweight and folds compactly. -the vinyl coded model is easy to clean -It is comfortable for the patient especially when the head is padded Cons: - it is not suitable to be used for a patient when spinal immobilization is necessary unless it is used with a backboard - you must be careful when setting the patient on the ground for long periods of time as soft tissue injuries may occur (If you are going to use this type of portable stretcher, make sure to see that the cross pieces are locked in place. And It is preferable to have four or more rescuers.)

Answer 72

When a wheeled stretcher cannot traverse narrow corridors and doorways, small elevators and stairways The newer model stair chair is designed with a track that can be lowered behind where the patient is sitting. This track comes into contact with the steps as the patient is moved downstairs and allows the chair to glide down steps with minimal effort exerted by the EMT. It still requires two rescuers, one at the head and one at the foot of the patient for stabilization of the device, but the new design eliminates the need to lift the chair while moving down the steps.

Answer 73

- altered mental status - suspected spinal injury - injuries to lower extremities

Answer 74

Before you begin, explain the procedure to them and make sure the straps are secure 1. One rescuer should stand behind the chair at the head and another rescuer , should stand at the foot facing the patient. a third rescuer , if available should prepare to spot by standing behind the rescuer , who will be moving backwards (either up or down the stairs) 2. As the chair is tilted back by the rescuer by the head , the rescuer at the foot should grasp the chair by its leg 3. Both rescuers should lift and begin to carry simultaneously.If the chair has wheels , they should not be allowed to touch the steps. 4. As the rescuers descend or ascend with the patient , the spotter should count out the steps and identify upcoming conditions

Answer 75

Backboards can be long or short. They are made of lightweight, plastic or composite materials with molded hand holds. Common styles are the Farrington (rectangular with round corners) and the Ohio (with mitered corners and tapering sides). It is used to protect the patient from rocky ground surfaces, and it could serve as a Spine Motion Restriction device to primarily move the patient until they are removed from backboard and place directly onto the stretcher mattress.

Answer 76

A vacuum mattress is a device that uses vacuum tech to conform to the shape of the patient, eliminating the need to pad any extra voids and it has several benefits such as it being: -lightweight -able to conform to the patient's shape. -able to fit within a basket stretcher -designed with several hand grips for the care providers to grasp when preparing to lift the patient *Can be as both a backboard and a moving device

Answer 77

The scoop or orthopedic stretcher is made to be assembled and disassembled around the patient. it can be used in confined areas where other conventional stretchers will not fit. ( It can also be used for pelvic fractures or bilateral femur , fractures to prevent further injury) *designed for up to 300 pound patients *PLEASE NOTE disadvantages of the scoop stretcher are that some devices are constructed entirely of metal which picks up the temperature of the environment and they not recommended for patients with suspected spinal injury

Answer 78

First of all, you need access to the patient from all sides and at least two rescuers are required. One to prepare and position the stretcher and one to move the patient. 1. Adjust the stretcher to the length of the patient 2. Separate the stretcher halves, and place one on each side of the patient. Gently roll the patient onto one side and slide half of the stretcher under the patient 3. If you haven't yet, examine the patient's back and return the patient to supine position 4. Assemble the head end of the stretcher 5. Roll the patient's body to the other side. Swing the remaining half of the stretcher into a closed assembled position. Latch the foot end of the stretcher. 6. Pad , the patient's head and any bony prominence with a pillow or folded sheet 7. Secure the patient with at least three body straps

Answer 79

Enabling you to completely immobilize a patient who is already on a backboard and to move him over any kind of terrain. The lightweight polyethynol style slides easily and smoothly over snow and rough terrain while protecting the patient from branches and twigs. There are two styles. One style has a welded metal frame fitted with a contoured chicken wire web. The other style has a tubular aluminum frame riveted to a molded polyethylene shell. Either style accommodates a scoop stretcher or Ohio type backboard. Basket stretchers also fit onto wheeled stretchers, which can be used to move the patient but be sure to secure the basket stretcher to the wheeled stretcher prior to any movement.

Answer 80

-For narrow and restricted hallways, such as those found mobile homes. - a patient on a backboard can be placed inside the flexible stretcher for moves downstairs or rough terrain - at the end of the day , just remember , the reeves flexible stretcher is designed for rapid spine motion restriction in tight spaces *Also known as a Reeves, flexible stretcher. It is a special transfer device made of canvas or synthetic materials with six large lifting and curing handles , three on each side.

Answer 81

Inhalation: the diaphragm and the intercostal muscles contract, which in turn increases the size of the thoracic cavity. This is because the diaphragm moves slightly downward and the intercostal muscles contact, pulling the ribs upward and outward. This creates a negative pressure in the chest which draws air in. Exhalation: the diaphragm and the intercostal muscles relax which decreases the size of the thoracic cavity. The diaphragm moves upward and the ribs move downward and inward, creating a positive pressure in the thorax and causing air to flow out of the lungs. Boyles law: as gas increases, pressure decreases and as gas decreases, pressure decreases

Answer 82

The diaphragm contributes about 60-70% of the effort to breathe when the phrenic nerve tells the diaphragm to contract. This nerve exits the spinal cord between vertebrae C3 and C5. whereas the intercoastal muscles contribute the remaining 30-40%. Thus , a significant injury that prevents the diaphragm from functioning properly will cause the patient's breathing to become ineffective.

Answer 83

If a spinal cord injury were to occur between C3 and C5, the phrenic nerve, may be damaged and the diaphragm will not receive a nervous impulse to contract, no longer allowing it to contribute to ventilation. The intercoastal muscles will also not work properly because the nerves that stimulate these muscles exit from the lower thoracic vertebrae. With an injury to the spinal cord high in the cervical vetrebrae the patient would not be able to breath spontaneously and would require artificial ventilation.

Answer 84

Filters and excretes waste from the blood (PRIMARY FUNCTION) * it also helps the body maintain its delicate chemical balance (just something else it does. This aids in maintaing a normal acid base balance in the body)

Answer 85

-two kidneys -two ureters -one urinary bladder -one urethra

Answer 86

To filter waste from the bloodstream and help control fluid balance. * the kidneys also play an important role in blood pressure regulation and red blood cell production *Waste is removed from the circulating blood for elimination and useful products are returned to the blood

Answer 87

To carry the waste from the kidneys to the bladder

Answer 88

To store the urine prior to excretion

Answer 89

To carry out the urine from the bladder to the outside of the body

Answer 90

Anaerobic metabolism is when the cells breakdown molecules without the presence of oxygen. Glucose crosses the cell membrane and normal glycolysis occurs with the production of pyruvic acid and the release of a small amount of ATP. Without the availability of oxygen , however , the pyruvic acid is not able to enter the next phase of metabolism and is instead converted to lactic acid. In conclusion , the byproducts of anaerobic metabolism are lactic acid and a small amount of ATP.

Answer 91

the byproducts of anaerobic metabolism are lactic acid and a small amount of ATP. if the acid accumulates, it produces an acidic environment and may disturb its function and stability. High acid levels inactivate enzyme function, disrupt cell membranes and ultimately lead to cell death. In addition the cell has little energy to perform its normal functions. Thus, an inadequate delivery of oxygen and glucose to the cells will result in very little energy production, reduce cellular function and the possibility of cellular damage. NaK+ pump failure too. -acidic cell enviroment due to lactic acid -inadeqate energy production -Sodium-potassium pump failure

Answer 92

Sodium is a positively charged ion that is found primarily outside the cell (primary extracellular ion) and potassium is a positively charged ion that is considered the primary intracellular ion because it is found primarily on the inside of the cell. For the body cells to perform their special functions , they require an alternating movement of sodium out of the cells and potassium into these cells. Molecules naturally move from an area of greater concentration to an area of lesser concentration and hence why sodium wants to move into the cell and potassium wants to move out of the cell but the sodium potassium pump works against the concentration gradient to push sodium out of the cell and potassium then is able to replace the recently pushed out sodium in the cell, the process described requires energy. 3 sodiums per 2 potassiums. The sodium potassium pump will fail if there's not enough energy , and this will allow the sodium to collect inside the cells, attracting water with it, making the cell swell and eventually undergo apoptosis. Cell death.

Answer 93

Minute ventilation, also known as minute volume, is the amount of air moved in and out of the lungs in one minute. You find it by multiplying the tidal volume (volume of air breathed in with each individual breath) by the frequency of ventilation in one minute. *An average sized adult has a tidal volume of 500 mL and an average respiratory rate of 12 BPM Thus, the calculated minute ventilation would be 500 x 12 = 6000 mL or 6L per min *It's important to under how to calculate minute ventilation because - a decrease in tidal volume decreases the minute ventilation - a decrease in the frequency of ventilation decreases the minute ventilation - a decrease in minute ventilation reduces the amount of air available for gas exchange in the aveoli - a decrease in minute ventilation can lead to cellular hypoxia - to ensure adequate ventilation the patient must have both an adequate tidal volume and an adequate rate of ventilation

Answer 94

Dead air space. For example, a patient breathing 200 mL of tidal volume but compensating by breathing 28 BPM has a minute ventilation of 5600 mL or 5.6 L / per minute which seems okay but dead air space prevents an adequate amount of air from reaching the aveoli for gas exchange. We don't NEED TO KNOW THIS BUT the formula for alveolar ventilation is ( tidal volume - dead air space) x frequency of ventilations per minute. Dead air space will always be approximately 150 mL

Answer 95

Chemoreceptors are specialized receptors that monitor the pH, carbon dioxide and oxygen levels in arterial blood. We have central and peripheral. *The central chemo receptors are located near the respiratory center in the medulla *The peripheral chemoreceptors are located In the aortic arch and the carotid bodies in the neck

Answer 96

Carbon dioxide and changes in the pH of the cerebrospinal fluid

Answer 97

The carbon dioxide can cross over the blood brain barrier and into the CSF to mix with H20 to from carbonic acid and thus this shows that the pH in the CSF is a direct reflection of the carbon dioxide level of the arterial blood. The relationship is summarized as follows: The greater the amount of carbon dioxide in the blood , the greater the amount of acid The lesser the amount of carbon dioxide in the blood , the lesser amount the of acid

Answer 98

An increase in arterial carbon dioxide increases the number of hydrogen ions in the cerebrospinal fluid stimulating an increase in the rate and depth of respiration to blow off more carbon dioxide A decrease in arterial carbon dioxide decreases the number of hydrogen ions in the cerbrospinal fluid , causing a decrease in the rate in depth of respiration to blow off less carbon dioxide

Answer 99

They are still somewhat sensitive to carbon dioxide and pH BUT ARE MAINLY MOST sensitive to the level of oxygen in arterial blood.

Answer 100

A Significant decrease in arterial oxygen content causes an increase in the rate and depth of respiration to increase the content of oxygen in the blood * stimulation by the central chemoreceptors and the peripheral chemoreceptors together has a greater influence on the rate and depth of ventilation than stimulation from either one by itself

Answer 101

Normally , a person's rate and depth of breathing are regulated primarily by the amount of carbon dioxide in the blood. This is known as hypercapnic or hypercabic drive but for patients with COPD they retain carbon dioxide in arterial blood as a result of their poor gas exchange. This leads to the central chemoreceptors becoming insensitive to the small changes that typically stimulate ventilation. So now the peripheral chemoreceptors then become the primary stimulus for ventilation. Instead of a small increase in carbon dioxide level being a strong stimulus for ventilation , the peripheral chemoreceptors rely on a decrease in the oxygen level to stimulate ventilation. You need hypoxia as the stimulus.

Answer 102

The force inside the vessel or capillary bed generated by the contraction of the heart and the blood pressure. Hydrostatic pressure exerts a push inside the vessel or capillary. It wants to push fluid out of the vessel or capillary, through the vessel wall and into the interstitial space. A high hydrostatic pressure would force more fluid out of the vessel or capillary and promote edema, due to excessive fluid outside the vessels.

Answer 103

Your left ventricle is failing and unable to pump lead effectively. The volume and pressure in the left atrium , pulmonary vein and pulmonary capillaries rise. Due to the blood backing up into the left atrium and pulmonary vessels , the increased hydrostatic pressure inside the pulmonary capillaries forces fluid out of them. The fluid starts to collect in the spaces between the aveoli and capillaries which reduces gas exchange effectiveness. Reducing blood oxygen content leading to cellular hypoxia , and causing the blood to retain carbon dioxide. The fluid eventually begins to collapse and fill aveoli, which is pulmonary edema.

Answer 104

The volume of blood ejected by left ventricle with each contraction Preload, myocardial contractility and after load

Answer 105

The pressure generated in the left ventricle at the end of diastole ( the resting phase of the cardiac cycle when the heart is full) preload pressure is created by the blood volume in the left ventricle at the end of the diastole.

Answer 106

As blood fills the left ventricle , the muscle fibers stretch to house the blood , the stretch of the muscle fiber at the end of diastole determines the force available to eject the blood from the ventricle. As the blood volume increases in the left ventricle , the increased stretch in the muscle fibers generates a relative contraction force. In short , the volume of blood in the ventricle automatically generates a contraction force powerful enough to inject it. There is , however , a limit to the applicability of frank starling's law. In the case of a severely dilated ventricle , where the fibers are overstretched , the heart will no longer be able to produce contractions strong enough to eject blood from the ventricle adequately

Answer 107

The resistance in the aorta , that must be overcome by contraction of the left ventricle to eject the blood. The force generated by the left ventricle must overcome the pressure in the aorta to move the blood forward. A high afterload places an increased workload on the left ventricle which can lead to eventual less ventricular failure. * in general , a decrease in either the heart rate or stroke volume will decrease the cardiac output

Answer 108

- a decrease in heart rate decreases cardiac output - an increase in heart rate if not excessive increases cardiac output - a decrease in blood volume decreases preload, stroke volume, and cardiac output - an increase in blood volume increases preload, stroke volume, and cardiac output - a decrease in myocardial contractility , decreases stroke volume and cardiac output - an increase in myocardial contractility increases stroke volume and cardiac output - neural stimulation from the sympathetic nervous system increases heart rate , myocardial contractility and cardiac output - neural stimulation from the parasympathetic nervous system decreases heart rate myocardial contractility and cardiac output - beta one stimulation from epinephrine increases heart rate, myocardial contractility and cardiac output - beta one blockade blocks beta one stimulation , which decreases heart rate , decreases myocardial contractility and decreases cardiac output - an extremely high diastolic blood pressure increases the pressure in the aorta, requiring a more forceful contraction to overcome the aortic pressure and a higher myocardial workload.And may weaken the heart and decrease the cardiac output over time - a reduction in the dystolic blood pressure decreases the pressure in the aorta which requires a less forceful contraction to overcome the aortic pressure and reduces the myocardial workload , which may improve the cardiac output in a weakened heart * also, note that a faster heart rate may increase cardiac output.However, if the rate is extremely fast, the cardiac output may actually decrease.Because the time between beats is so short.There is not enough time for the ventricles to fill. In turn , this reduces the preload and cardiac output. (Normally when HR is greater than 160 BPM)

Answer 109

Cardiac output and systemic vascular resistance Cardiac output x systemic vascular resistance = BP

Answer 110

- an increase in cardiac output increases the blood pressure - a decrease in cardiac output decreases the blood pressure - an increase in the heart rate increases the cardiac output , which in turn increases the blood pressure - a decrease in the heart rate decreases the cardiac output , which in turn decreases the blood pressure - a increase in stroke volume increases cardiac output , which in turn increases the blood pressure - a decrease in the stroke volume decreases the cardiac output , which in turn decreases the blood pressure - an increase , in systemic vascular resistance increases the blood pressure - a decrease in systemic vascular resistance decreases the blood pressure

Answer 111

-An increase in blood pressure increases cellular profusion - a decrease in blood pressure decreases cellular perfusion

Answer 112

Baroreceptors are stretch sensitive receptors located in the aortic arch and carotid sinuses. As the pressure inside the vessel's change , it decreases or increases stretch of the fibers of the baroreceptors. They detect changes in the blood pressure. Having detected the change in blood pressure , the baroreceptors send impulses to the cardio regulatory sensor in the medulla of the brainstem , to make compensatory altercations in the blood pressure

Answer 113

Cardioexcitatory center and cardioinhibitory *These centers control heart rate and stroke volume

Answer 114

An increase in blood pressure leads to an increase in baroreceptor stretch , which leads to an increase in impulses sent to the medulla , which leads to an increase in parasympathetic nervous system which leads to decrease in sympathetic nervous system , which leads to a decrease in heart rate , which leads to decreasing contractility , which leads to decrease in blood pressure

Answer 115

A decrease in blood pressure leads to decrease in baroreceptor stretch which leads to a decrease in impulses sent to the medulla , which leads to a decrease in the parasympathetic nervous system which leads to an increase in sympathetic nervous system , which leads to an increase in heart rate , which leads to increase in contractility , which leads to increase in blood pressure

Answer 116

Stimulation of the adrenal medulla results in the secretion of the hormones , epinephrine and norepinephrine. Epinephrine stimulates alpha1 and alpha2 receptors, producing vasoconstriction , which increases systemic vascular resistance and blood pressure. Epinephrine also stimulates Beta1 receptors in the heart, leading to an increase in heart rate and myocardial contractility. This Raises the stroke volume and cardiac output and subsequently raises the blood pressure. norepinephrine predominantly stimulates alpha1 and alpha2 receptors. Alpha 1- vasoconstriction Alpha 2- controls alpha 1 Beta 1- increases HR Beta 2- bronchodilation

Answer 117

The neonate typically weighs 3.0-3.5kg and the head accounts for 25% of the weight. The initial birth weight of neonate normally drops 5-10% in the first 2 weeks but the lost weight is normally regained shortly thereafter. The baby's weight will continue to increase throughout infancy with proper nutrition such as breast milk or formula. As this first year progresses, the infant will consume other soft foods without yet having teeth but during infancy , the primary teeth will begin to emerge , and the baby will slowly be introduced to solid food. *infancy is marked from 1 month to 1 year

Answer 118

-An infant's airways are shorter , narrower , less stable , and more easily obstructed than those of adult. -Until 4 weeks of age , infants are primarily nose breathers. they have fewer alveoli with decreased collateral ventilation. -Thier lung tissue is also fragile and prone to trauma from pressure. -Infants also have immature accessory muscles, which makes them easily susceptible to early fatigue from labored breathing. - the infant's less rigid chest wall and more horizontalally placed ribs , promote diaphramatic breathing (belly breathing) - if an infant's respiratory rate is rapid , it could lead to rapid heat and fluid loss

Answer 119

- most of the neonates , immunity is based on the antibodies that he received through the placenta from his mother during pregnancy ( this is called passive immunity and is normally retained through the first 6 months of life) - infants are more susceptible to infections and disease , so it is important to immunize them (vaccination) *breastfeed babies will have immunity for as long as the breastfeeding continues because they are rechieving antibodies from mom

Answer 120

Blinking, startling, rooting sucking , swallowing, stepping, gagging, and grasping. These reflexes help them survive, such as their strong coordinated sucking and gag reflexes.

Answer 121

Babies are born with fontanelles, or soft spots on the skull that allow the head to be compressed and passed through the birth canal during delivery. * The fontenelle's allow room for rapid expansion and growth of the brain during infancy. *The posterior fontanelle closes by 3 months and the anterior fontanelle closes between 9-18 months

Answer 122

If the child is dehydrated, the fontenelle's may appear to pressed or sunken in relation to the rest of the skull. The frontelle may appear full or raised if the infant has an infection or injury , causing an increase in intercranial pressure.

Answer 123

- track objects with his eyes - focus on objects 8-12 inches away - recognize familiar faces - display primary emotions and facial expressions - hear and recognize some familiar sounds and voices - move in response to stimuli

Answer 124

- sit upright in a high chair - make one syllable sounds (ma, mu, da, di) - raise and support their upper body when they are on their stomach - grasp and shake hand toys - push down on his legs and feet when held over a firm surface - follow moving objects with their eyes - recognize familiar objects at a distance - begin to babble and try to imitate familiar sounds

Answer 125

- walk with help - know their own name - sit without assistance - crawl and creep on their hands and knees - put objects into containers - poke objects with fingers - response to simple requests and "no" - say mama or Dada - imitate some words, gestures and facial expressions - begin to use objects like brushes , cups or phones correctly - finger feed themselves

Answer 126

Heart rate: Average is 70 BPM Respiratory rate: 12-20 BPM Blood pressure: 120/80 mmhg Temperature: 98.6⁰F *Early adulthood is when a person is 20-40 years old

Answer 127

Most people reach peak physical condition , and this leads to the capability at risky activity. However, once young adults reached their peak, their physical condition.Because slow down , they start gaining weight , storing fat, experiencing decreased muscle tone, and their spinal disks settle.

Answer 128

People generally take on more responsibility and become more independent. - some choose to leave their parents home and start their own - most people develop romantic and affectionate relationships and some may even marry and have children (childbirth is most common in this group) - it is also the time that many adults finish school and find a career ( they experience the highest levels of job stress during this period) - even with all these changes, early adults are more capable of coping with their stress than when they were younger

Answer 129

Because of internal respiration and external respiration , the processes in which fresh oxygen replaces waste carbon dioxide. This is a gas exchange that takes place between the alveoli and the capillaries in the lungs (external), and between the capillaries and the cells throughout the body (internal). As noted earlier, ventilation is the mechanical process of moving air in and out of the lungs and respiration is the psychological process of gas exchange. *Oxygenation is the process of the cells becoming perfused with oxygen

Answer 130

It typically occurs due to ventilation perfusion mismatch. This is when there is a lack of available oxygenated air in the alveoli even though perfusion (blood flow) to the alveoli is adequate, or when the alveoli are adequately oxygenated but perfusion to the alveoli is poor or when there is combination of both poor ventilation and poor perfusion. Hypoxemia is low oxygen content in arterial blood.

Answer 131

- occulated airway - inadequate breathing - an inadequate delivery of oxygen to the cells by the blood (hypoperfusion or shock) - inhalation of toxic gases (carbon monoxide) - lung and airway diseases ( asthma and emphysema) - drug overdose that suppresses the respiratory center in the brain ( morphine, heroin and other narcotics) - stroke - injury to the chest or respiratory structures - head injury -etc many more that can create a blockage to the airway , or produce inadequate breathing by depressing the respiratory centers in the brain, interfering with gas exchange at the level of the alveoli or restricting the movement of the chess wall *hypoxia is an inadequate amount of oxygen being delivered to the cells.

Answer 132

- Tachypnea - Dyspnea - Pale, cool, clammy skin (early sign) - Tachycardia - Increased Blood Pressure - restlessness and agitation (from hypoxic cells) - disorientation and confusion (from high CO2 levels in the blood) - headache

Answer 133

- Tachypnea - Dyspnea - Cyanosis ( bluish gray color that may be found in and around several areas of the body. Including the lips , mouth , nose , fingernail beds , conjunctiva (between bottom of eyelid and eyeball, normally red), oral mucosa (between the lips, and gums, and tongue). Cyanosis has a blue like color affecting skin, mucous membrane, and nail beds. - Tachycardia that may lead to dysrhythmias and eventual bradycardia - severe confusion - loss of coordination - slow reaction time - AMS - Seizure

Answer 134

- sleepy appearance ( from high carbon dioxide levels in the brain) - head bobbing ( head bobs upward with inhalation and downward with exhalation) with droopy eyelids (from high CO2 in the brain)

Answer 135

Infants and young children normally have higher heart rates than adults. A normal heart rate for a week old is 100-180. So a heart rate of 80 is very slow for an infant and hypoxia is the primary cause of bradycardia in this group. In infants, children and adults , bradycardia is a sign of severe hypoxia and impending respiratory and cardiac arrest.

Answer 136

When the patient's breathing status is inadequate either rate or tidal volume. This forces air into the patient's lungs, aka helps them be ventilated.

Answer 137

- interruption of the nervous system's control and stimulation of the diaphragm or the external intercoastal muscles may result from a brain injury, drugs that depress the central nervous system or from neuromuscular diseases - structural damage to the thorax may interfere with the action of the chest. This impedes the ability of the thorax to generate pressure changes necessary to draw air into the lungs for inhalation and to allow air flow out of the lungs during exhalation. pain associated with chest injury: frail chest (2 or more ribs fractured in 2 or more places), rupture or injury to the diaphragm or compression of the chess wall can reduce actions of the chest - increased airway resistance reduces air flow through the respiratory track and reduces the amount of air in the alveoli. This makes less oxygen available for gas exchange. An increase in airway resistance can occur from bronchoconstruction or from inflammation inside the vessel - disruption of airway patency can occur from swelling caused by infection, allergic reaction, burns from trauma, from foreign body obstruction , or from loss of muscle tone associated with an alternative status or unresponsiveness. Reduction or loss of airway patency reduces the tidal volume, minute ventilation alveolar ventilation, and volume of gas in the lungs for gas exchange - a neuromuscular disease may affect the muscles of the respiration , leading to a progressive ineffective action of the chest without effective action necessary intrathoracic experiences , respiratory distress will occur and eventually failure

Answer 138

True. These conditions make it harder for the patient to breathe, and he must work harder to breathe, which demands more energy and he becomes more hypoxic.

Answer 139

-The noses and mouths of infants and children are smaller than those of adults.Thus, they are more easily obstructed by foreign bodies, swelling, blood, mucus and secretions. -Infants are nose breathers, meaning they want to breathe through their nose and not the mouth.Thus , it is especially important to keep the nose clear of obstructions

Answer 140

-Because the tongue of an infant or child is relatively large in proportion to the size of the mouth, it takes a more room, therefore, an infant or a child is more prone to airway obstruction by posterior displacement at the tongue at the level of the phraynx -The epiglottis is more U-shaped and can protrude into the pharynx contributing to obstruction.

Answer 141

The trachea and lower airway passages of infants and children are more narrow, softer and more flexible than those of adults. Thus, airway obstructions occur more easily from mucus, puss, blood secretions, swelling, constriction and kinking of the trachea, with flexion or extension very small reductions in the diameter of the lower airway results in significant airway obstruction and high resistance to airflow, reducing effective breathing and oxygenation. - the young child's head is larger in proportion to his body, the head tends to forward, flexing the neck and potentially collapsing the trachea , when the child is placed on his back for oxygenation or ventilation for all children , adjust padding to achieving a neutral alignment

Answer 142

- the Chest wall in an infant or a child, is softer and more pliable than an adult. This leads to a much greater compliance (elasticity) or movement, during ventilation. Because the chest expands so easily, it is much easier for the EMT to overtinflate the lungs and causs possible lung injury , especially because a much lower tidal volumes is required in children. Overdistention of the alveoli is one of the primary causes for aveolar injury during positive pressure ventilation. -infants and children rely more on the diaphragm for breathing. The intercostal muscles contrbute less in normal breathing and act more like accessory muscles. This is why retractions are more prominent in infants and young children compared to adults. -When you perform ventilation on an infant or child, the chest should expand and rise easily. If the chest does not rise, you should assume that the airway is not adequately open or is occluded by an obstruction or the ventilation volume is inadequate.

Answer 143

-Infants and children are smaller and have more limited oxygen reserves than adults.Therefore , they have less oxygen in the lungs available during periods of inadequate breathing or apena. - They have twice the metabolic rate of adults , causing them to use oxygen at a much faster rate - Thier smaller oxygen reserves and greater metabolic rate cause infants and children to become hypoxic more rapidly than adult patients *Hypoxia is the most common cause of cardiac arrests in children.

Answer 144

When the upper airway is partially obstructed by the tongue or by relaxed tissues in the pharynx. It can be corrected by performing the head tilt chin lift maneuver.This lifts the base of the tongue from the back of the pharynx. Never ever ever use head tilt chin lift on a suspected spinal injury patient.

Answer 145

When the muscles around the larynx spasm and narrow the opening into the trachea. Air rushing through the restricted passage causes the sound.

Answer 146

When there is presence of blood, vomitus , secretions or other liquid in the airway. *suction to relieve gurgling

Answer 147

Like a bird cawing

Answer 148

Do to a significant upper airway obstruction from swelling in the larynx. It may also be heard if a mechanical obstruction by food or other objects is present. It sounds like a harsh high pitch sound heard during inspiration.

Answer 149

- the adjunct must be clean and clear of obstructions - the proper size airway adjunct must be selected to avoid complications and ineffectiveness - the airway adjusts do not protect the airway from aspiration of secretions , blood vomitus, or other foreign substances into the lungs - the mental status of the patient will determine whether an adjunct can be used.The patient's mental status must be continually and carefully monitored.If the patient becomes responsive or gags , remove the airway adjunct. - a head tilt chin lift or jaw-thrust maneuver must still be maintained even when an airway adjunct is in place and properly positioned

Answer 150

The oropharyngeal airway is a semi-circular device of hard plastic or rubber that holds the tongue away from the back of the airway. One OPA is tubular and the other has a channeled side. Both are disposable and come in a variety of sizes.

Answer 151

The patient must be completely unresponsive and have no gag or cough reflex. If inserted in such a patient , it may cause vomiting or spasm of the vocal cords which further compromises the airway.

Answer 152

1. Select the properly sized airway adjunct by measuring it from the front teeth to the angle of the jaw or from the corner of the month to the tragus of the ear. 2. Open the patient's mouth using the cross finger technique. An adults insert the airway upside down, the tip pointing to the roof of the mouth 3. When the airway contacts the soft palate at the back of the roof of the mouth gently rotate it 180⁰ while continuing to advance it until the flat flange at the top of the airway rests on the patient's front teeth. Following this procedure reduces the chances of the tongue being pushed back and obstructing the airway. The airway can also be inserted sideways in the corner of the mouth and rotated 90⁰ while being pushed into position.

Answer 153

With the use of a tongue depressor. The tongue depressor is inserted into the mouth until its tip is at the base of the tongue.The tongue is then pressed down toward the mandible and forward with the tongue depressor. The airway is inserted in its normal anatomical position until the flange is seated on the teeth. This is the peferred method of airway insertion in infants and children

Answer 154

The nasopharyngeal airway is a curved hollow tube , a soft plastic or rubber with a flange or flare at the top end and bevel at the distal end. The airway adjunct comes in a variety of size based on a diameter of the tube.

Answer 155

When the oral airway cannot be inserted because of -clenched teeth -biting -Injuries to the maxilla or face -in those patients who are unable to tolerate an OPA BUT! we would not use an NPA If the patient has suspected fracture to the base of the skull or severe facial trauma

Answer 156

False. It can still cause gagging, vomiting , spasms of the vocal cords and like the OPA, it does not protect the trachea and lungs from aspiration of blood, vomitus, secretions or other foreign substances.

Answer 157

Although the tube is lubricated, insertion is painful and may cause injury to the nasal mucosa, causing a nose to bleed and allowing blood to enter the airway.Resulting in possible obstruction or aspiration, it is still necessary to maintain a head tilt chin lift or jaw-thrust maneuver when the airways inserted.

Answer 158

1. Measure it from the tip of the patient's nose to the tip of the earlobe. It is also acceptable to measure the airway from the tip of the nose to the angle of the jaw. The diameter of the airway must be such that it can fit inside the patient's nostril without blanching (turning white due to obstruction) the skin of the nose. 2. Lubricate the outside of the airway well with the sterile WATER SOLUBLE LUBRICANT , this eases the insertion and lessons to chance a trauma to the nasal mucous lining 3. Inserted the device in the larger or more open nostril, the bevel should be facing the septum or floor of the nostril. The devices is inserted close to the midline along the floor of the nostril and straight back into the nasopharynx, if you meet resistance, rotate the device gently from side to side, as you continue to insert it, If you still meet resistance, remove the airway and try the other nostril. When the device is properly inserted, the flange should lie against the flare of the nose. 4. Check to make sure that air is flowing through the airway during inhalation exhalation, if the patient is spontaneously breathing and no air movement is felt through the tube remove it and attempt reinsertion in the other nostril.

Answer 159

In very young patients , their nasopharyngeal airway is so small that it is easily obstructed by secretions and other upper airway substances and children may have larger adenoids (clot of tissue in the back of the nose) which makes insertion of the NPA difficult. Even if insertion is possible , the large adenoids can compress the nasopharyngeal airway and increase the resistance in the airway, along with bleeding and injury to the nose. This makes the use of an NPA device very ineffective in childern.

Answer 160

-Respiration -Pulse -Skin -Pupils -Blood pressure -Pulse oximetry (SPO2) *Additional vital signs we may measure -Capnography (end-tidal CO2 if protocol permits) -Blood glucose -Pain assessment -Body temperature *Baseline vitals are the first set of vitals you take to compare with later vitals *In an unstable patient, reassess every 5 minutes *In an stable patient, reassess every 15 minutes

Answer 161

-A sphygmomanometer (blood pressure cuff) in adult and pediatric sizes -A stethoscope to take BP and and listen to lung sounds -A wristwatch to time pulse and respiratory rate -A penlight to examine pupils -A pair of shears to cut clothing away -A pen and notebook to record info -PPE equipment such as eyewear, gloves, and masks -A pulse oximeter to assess SPO2 -A 12-lead cardiac monitor to accquire a 12-lead ECG tracing -End tidal CO2 if protocol permits -A glucometer to measure BGL -A pain scale tool -Thermometer to measure core body temperature

Answer 162

-Respiratory rate -Respiratory quality -Respiratory rhythm

Answer 163

When they are under 8 or over 24 *RR is typically determined by counting the breaths in a 30-second period and multiplying by 2. (One breath = one inhalation + one exhalation) *We also pretend to check to check radial pulse when assessing RR because if the patient knows you are counting/assessing the respiratory rates, it can influence the rate. Hence, pretend to check the radial pulse and cross the patient's arm over the lower chest while counting respirations.

Answer 164

1. Determine if the patient seems to be in respiratory distress 2. Assess his mental status and pay attention to his speech pattern For example, a patient breathing 8 breaths per minute who is alert, orientated, and able to answer your questions without gasping for breath or showing a struggle to breath, 8 may be his normal respiratory rhythm and no intervention is needed; whereas a patient who is struggling may require assistance/ventilation. Base your determination of the patient's condition and not if they fall into normal ranges because normal is different for everyone, for example a patient breathing 15 per minute may in fact be in respiratory distress if clinical signs show that is the case.

Answer 165

The resting respiratory rate in the elderly population is typically higher, with an average of 20-24 resting BPM and elderly patients may have a decreased tidal volume. For example, a resting rate of 23 may be alarming in an 18 year old patient but not a 67 year old patient.

Answer 166

1. The patient will not be able to sustain that rate for a long because of the increase in workload to breathe and the respiratory muscle fatigue that will follow 2. The rate is so fast that the lungs don't adeqaute time to properly fill, leading to a drastic reduction in tidal volume

Answer 167

-the volume of air moving in and out of the lungs with each breath (tidal volume) -the volume per minute (minute ventilation) -and how well the air is moving

Answer 168

Positive Pressure Ventilation (PPV)

Answer 169

A normal quality correlates with an adequate tidal volume and a abnormal quality is usually a indication of an inadequate tidal volume. An abnormal quality may be shallow, labored, or noisy.

Answer 170

- average chest wall movement, which is at least 1 inch of expanison - the patient does not use the accessory muscles of the chest , neck or abdomen while breathing - rate is normal (12-20, varies by age) and inhalations are neither prolonged nor excessively short - exhalation is typically twice as long as inhalation - normal breathing is quiet

Answer 171

- slight chest or abdominal wall expansion upon in inhalation (typically indicates inadequate tidal volume and requires PPV by BVM or CPAP depending on the patient's conditonn and assessment findings)

Answer 172

- the patients is working hard to breathe - abnormal sound breathing that may include grunting or stridor (a harsh high pitched sound) - the use of accessory muscles in the neck , chest or abdomen to breath - nasal flaring - sometimes gasping - in infants and children , there may be retraction of the skin muscles and other tissues around the clavicle and between the ribs

Answer 173

the use of accessory muscles in the neck and chest usually indicate that the patient's struggling to inhale, whereas excessive abdominal muscle use is usually an indication of trouble exhaling. ** the use of accessory muscles requires an increase of energy expended to breathe which may cause fatigue

Answer 174

-snoring -wheezing -gurgling -crowing -stridor

Answer 175

Auscultate the chest with a stethoscope to determine if breath sounds are present on both sides and to identify any noisy breath sounds not audible to the ear alone. In a trauma patient, you auscultate primarily to determine whether breath sounds are present or absent, whereas in the medical patient, you should focus on abnormal breath sounds. This may include wheezing, rhonchi, and crackles (rales)

Answer 176

The regularity or irregularity of respirations

Answer 177

This can be easily influenced by speech, activity , emotions and other factors in the conscious and alert patient. However, abnormal respiratory rhythm in an patient presenting with AMS is a serious concern. It may indicate a medical illness, chemical imbalance, or brain injury.

Answer 178

- cheyne stokes - biot - apneustic - ataxic - agonal - kussmaul - central nuerogenic hyperventilation

Answer 179

The respiratory rate and tidal volume gradually increase and gradually decrease , followed by a period of apena for up to 10 seconds. Pattern repeats.

Answer 180

Similar to cheyene stokes except that the tidal volume doesn't change

Answer 181

Prolonged periods of inhalation

Answer 182

An irregularly inregular pattern of rate and tidal volume

Answer 183

Long periods of apena with a gasping breath interposed

Answer 184

A rapid respiratory rate with a deep and labored tidal volume

Answer 185

A sustained deep and rapid respiratory rate of at least 25 breaths per minute but with a regular pattern.

Answer 186

-Caves -Wells -Tankers -Vats -Manholes -Sewers -Culverts -Underground utility vaults -Silos -Closed garages -etc

Answer 187

Such areas may be low in oxygen and or high in toxic substances such as methane

Answer 188

Appropriate Self-Contained Breathing Apparatus (SBCA) in place. PLEASE ENSURE YOU HAVE SCBA ON. many well meaning rescuers have failed to recognize the risk of confined space entry and have themselves become victims along with the patient's they planned to rescue.

Answer 189

Your safety is always the #1 priority so you must wait for the police to arrive so that they can secure the scene, only then will you be allowed to enter. Even if you only suspect It is a crime or a threat, do not enter the scene and wait for police backup.

Answer 190

- while still several blocks away, turn off the siren and emergency lights (draws less attention and allows you to survey the scene, if the scene seems too dangerous, do not stop and simply pass it. Await police support) -practice parking 2-3 houses away (so you can study the scene. In crimes involcing guns, this will typically put you outside the killing zone)

Answer 191

The area controlled by hostile fire. If someone inside the house has a gun , an area about 120⁰ in front of the house is at least partially exposed to hostile fire.This area can be much larger depending on the location of the house.For example , one on the corner lot and on the mobility of the person with the gun , the killing zone is not static and is always subject to change

Answer 192

-study the mood of the crowd. If it is choatic, don't let yourself to be pulled in. If it is hysterical, again, don't be pulled in. If it is hostile to your presence, you can either take the patient with you and leave or await police support.

Answer 193

- walk on the grass for a quieter , less obvious approach - if you are using a flashlight, hold it beside you, not in front of your body , so that you don't make your body a possible target - if you're walking with a partner, walk single file, the last person in the line should carry the jump kit. This will leave the person at the front of the line hands free , and better able to react to any problems they may be encountered - only the person in line should carry a flashlight because all those behind would only illuminate the front - make a mental map of possible places of concealment and cover such as trees that will both hide you and stop bullets. Keep illuminating or scanning dark corners for movement - take a moment to look at windows and corners. If you need to take a longer look , change positions to make it harder for a hostile person to focus on you/ find you - stand to the side of the door when you knock on it.Never in front of it to avoid being a target for someone shooting , springing out or reaching to grab at you. Standing to the knob side , prevents a door that opens outward from blocking you. If the door opens inward , the person opening it will most likely be looking toward the hinge side, letting you see them before they see you. - as soon as the doors open, assess the situation before you decide whether to retreat or to have your partner move the ambulance up to the front of the building. as you enter, leave doors open behind you to ensure an escape route. Likewise , never appear to block the patient's route of escape

Answer 194

-if you discover it is indeed a crime, be wary that the perpetrator may be nearby. Police intervention will be necessary and always be ready to retreat. - once the scene is secured, limit the number of responders at a possible crime scene to only what's necessary - do not allow bystanders to touch or disturb the patient or his surroundings - introduce yourself to the patient carefully and say that you're there to help him. Crime patients are often confused and afraid - be alert to the possibility that the patient at the crime scene be a perpetrator. always keep track of the patient's hands in a hostile situation and be prepared for the possibility at such a patient may suddenly reach for a weapon - if possible, have one EMT keep a constant watch on the bystanders and the surrounding area while you work on the patient to alert you if a scene begins to turn dangerous - your first priority is yourself and your partner. Your second is your patients care but also be mindful of police requests. - take extreme care not to disturb any evidence not on the patient's body (broken glass, foot steps, soil, tire tracks, etc) - never touch or move suspected weapons unless it is necessary for treating the patient's injuries. Many guns are loaded and dangerous due to accidental discharge. Pick up a gun by the edge of the grip and use a gauze pad to pick up a knife at the very edge of the blade to not distribute any fingerprints. - wear gloves the whole time to avoid leaving fingerprints - if you need to tear or cut away clothing to expose a wound, make sure you do not cut through a bullet hole or a knife slash in the clothing , keep the clothing and submit it as evidence to the police - if the patient was strangled or tied with a rope or other material cut at a point away from the knot instead of untying it because the knot can help identify killers - if the patient is responsive , do not burden him with questions about the crime. Chismoas y chimosos - realize that the patient will probably show extremes of emotions. Be prepared to handle it. - document who is at the crime when you arrive - if the patient is obviously dead when you arrive , do nothing and disturb nothing. Summon the police. You wouldn't do resuscitation or treat them if they have extreme injuries or they have been obviously dead for a while; dependent lividity or decapitation. Follow local protocols.

Answer 195

How the patient was injured. It includes the strength, direction and nature of the forces that caused the injury. The mechanism of injury is the basis for your index suspicion

Answer 196

The degree of your anticipation that the patient has been injured or has been injured during a specific way based on your knowledge that certain mechanisms usually produce certain types of injuries. Index of suspicion isn't perfect and it is only an assumption, for example you may see a mess up motor vehicle accident and think the patient is in critical condition but it turns out they're just fine. Focus more on the findings the patient presents with than MOI as they are better indicators of the patient's condition.

Answer 197

- falls - vehicle crashes - motorcycle crashes - recreational vehicle crashes (snowmobile or ATV's) - contact sports involving intentional or unintentional collision (football, rugby etc) - recreational sports (skiing, diving, or basketball etc) - pedestrian collision with a car, bus, truck, bike, etc - blast injuries from an explosion - stabbings - shootings - burns

Answer 198

look for evidence a fall did happen. (Fallen ladders, collapsed scaffolding, ropes in a tree or on buildings, trees nearby, stairs, balconies, roofs and windows) Now determine: - distance the patient fell - surface the patient landed on - body part that impacted first

Answer 199

- head on or frontal collision - rear end collision - side or lateral impact collision - rotational impact collision - rollover Car crashes produce some of the most lethal MOI's because forces are applied to the body, producing widespread injury to the organs , bones , muscles , nerves and blood vessels

Answer 200

External impact to the vehicle from an outside force and internal impact to the vehicle caused by the patient's body. One EMT should quickly walk around all sides of the vehicle to identify the points of impact. That EMT should also conduct a close inspection of the passenger compartment for signs of impact that correlate with specific types of injury. *In an MVA, most people don't actually die from ejection but rather when the vehicle rolls on top of them

Answer 201

- deformity to the vehicle greater than 20 inches - intrusion into the passenger compartment - displacement of a vehicle axle (central shafts that connect to the wheels) - rollover

Answer 202

- impact marks on the windshield caused by the patient's head - missing rear view mirror - collapsed steering wheel - broken seat - side door damage - cracked or smashed dashboard - deformed pedals - use of restraint devices and deployment of airbags (a airbag deployment may cause damage to the windshield that can be mistaken for a patient head banging it. Examine patient's head to search for trauma and determine what hit the windshield.)

Answer 203

-Head-on (the rider is propelled forward off the bike) -Angular impact (the rider strikes an object) -Ejection ( the rider is thrown from the motorcycle and impacts the ground, the object involved in the collision or both -"Laying the bike down" ( the rider purposefully lays the bike down on its side to avoid another potentially more serious impact) *it is important to document if the patient used a helmet since it can prevent/reduce severity of head injury

Answer 204

-Snowmobiles or ATVs are commonly operate on uneven terrain, a factor that contributes to rollovers -Snowmobiles can travel at high speed , producing severe impact upon collision with trees , rocks or other vehicles. -a "clothesline" injury can occur with when a rider is pulled off the vehicle by a low branch, wire, rope or other low-hanging objects. severe trauma to the neck and airways are common.

Answer 205

-You must expose and assess the patient's body to confirm or rule out a stabbing or gunshot. -with an unresponsive patient, completely expose them and look for a penetrating injury. -whether blood is visible at the scene or around the body, be sure to log roll the patient inspect the posterior body for open wounds. - heavy Coats, dark clothing, poor lighting, dark environments or dark hair, hide blood very well. you must inspect the body carefully for open wounds. For example, open wounds to the chest may not produce much bleeding but can be lethal if not immediately identified and managed.

Answer 206

- gasoline - fireworks - natural gas - propane - acetylene - grain dust in grain elevators (wheat/corn in grain factories explode with storms) - criminal intent

Answer 207

- the pressure wave associated with the blast - flying debris - the collision that results when a patient propelled by the blast , contacts the ground or other objects *also note burns are common at blast scenes

Answer 208

Call for additional resources. This can include law enforcement, fire rescue or utility company personnel, a hazardous materials team, additional basic life support unit or advanced life support team. Try to make any calls for additional assistance before contacting patients, as after you have made contact, you're likely to completely focus on the patient's needs and not call for help. *Some cases in which determining # of patients may be difficult are during a multiple vehicle collision during a night time snowstorm or a suspected carbon monoxide poisoning in a multifamily home ****IF AN EXCESSIVE # OF PATIENTS ARE PRESENT AND ARE BEYOND YOUR UNIT'S RESOURCES AND CAPABILITIES: INITATE YOUR LOCAL MULTIPLE-CASUAL PLAN, AND START TRIAGING AND PRIORITIZING PATIENTS

Answer 209

You must consider your own safety and if possible, move as rapidly to remove yourself and the patient from the scene and or call for additional resources as needed.

Answer 210

To identify and manage immediately life threatening conditions (WHICH MUST BE TREATED BEFORE MOVING ON IN YOUR ASSESSMENT) to the airway, breathing, oxygenation or circulation

Answer 211

-General impression -AVPU/LOC's -Chief complaint/ life threats -ABC's and oxygenation -transport decision BUT ACCORDING TO THE BOOK 1. form a general impression of the patient that includes identifying and controlling major bleeding 2. Assess the levels of consciousness (mental status) 3. Assess the airway 4. Assess breathing 5. Assess oxygenation 6. Assess circulation 7. Establish patient priority

Answer 212

The key is to assess and manage any immediate life threats to the airway, breathing, oxygenation and circulation during the first 60 seconds

Answer 213

- if you suspect spinal cord or vertebral injury - patient complains of neck or back pain - patient complains of loss of motor or sensory function - patient complains of abnormal sensations in the extremities

Answer 214

There are three types of self-resriction. In all, instruct the patient to bring his head and neck in line with his umbilicus , and not to move it. - if there is no evidence of possible spinal injury, and the patient is reliable. The patient is placed directly on the stretcher mattress in position of comfort and strapped in - if there is possible spinal injury or the patient is not reliable, a cervical collar is applied, and the patient is then placed on the stretcher mattress in a supine position and strapped in. In this case , the backboard may be used as a moving device to the stretcher. ( there is another variation in which the patient is not reliable or there is suspicion of spinal injury but in this version the patient is log rolled onto a vacuum mattress , and the patient remains in the vacuum mattress during transportation on the stretcher) Lastly, there is another version in which we do not rely on the patient on self restricting themselves, but rather an EMT manually stabilizes the head and neck with his hands to keep the patient from moving. a cervical color is applied. The patient is then logged rolled onto a backboard, a head immobilization device is strapped. The patient is strapped to the backboard. And then the patient is placed on the stretcher and secured for transport. In this case , the patient remains on the backboard during transport

Answer 215

The patient's answer to the question: "Why did you call EMS today?" *Chief complaints can vary, for example: " My stomach hurts" pain " im having slurrrreed speechds" abnormal function " She doesn't seem to be herself" a change in function from normal Or an observation made by you: bizarre behavior indicating a possible psychiatric problem *The original chief complaint is not always the true chief complaint: In a patient who has a deformed leg may state that their chest is killing them and although the deformed leg seems obvious , they may have truly called for you to help them with their chest pain. So no. The original complaint is not always the true chief complaint

Answer 216

"Why did you call EMS today?" This tends to focus the patient on what has changed to make him more concerned.For example, he may now state "this morning i vomited bright red blood"

Answer 217

It may need to be established through family, friends or bystanders or from the environment itself. Ask bystanders, "can you tell me what happened?" and "What was the patient complaining of anything before he became unconscious" You may also need to ask "Was the patient responding in any way when you were talking to them?" * if no one can be provide you an answer , the chief complaint may be what you infer from observation

Answer 218

-Trapezius pinch (Grasp 1-2 inches of the trapezius muscle and pinch) -Supraorbital pressure (slide your finger under the upper ridge of the eye socket and apply upward pressure) -Sternal rub (Apply hard downward pressure to the center of the sternum with your knuckles) -Earlobe pinch (Pinch the soft tissue of your earlobe) -Armpit pinch (pinch the skin and underlying tissue along the margin of the armpit) *Watch the patients face and body. Face for facial grimace and body for any movements to determine if they are responding to the pain stimuli. If the patient does not respond to the pain stimuli and they are unconscious, they are considered to be in a coma.

Answer 219

-Nail bed pressure (Apply point pressure to the cuticle of the nail bed) -Pinch to the web between thumb and index finger -Pinch to the finger, toe, hand, or foot

Answer 220

Attempts by the patient to remove the stimulus or avoid the pain. For example, withdraws from stimulus would be a patient pushing your hand and withdraws from pain would be when they sway backwards to get away from you.

Answer 221

When patients with a spinal cord or brain injury respond in an abnormal manner to pain stimuli. Such as flexion posturing (Decoricate, arches back and flexes arm INWARD) and extension postering (Decerebrate postering, arches back and extends arms straight OUT parallel to the body. *In patients with a spinal cord injury, besides decerebrate and Decoricate, They may only respond to pain on one side of their body or only above the site of injury

Answer 222

Central because with a peripheral pain stimuli, the impulse of pain goes straight to the spinal cord and sends a message for the muscle to move, bypassing the brain and hence giving no indication of brain function and leading to mistakes in your assessment. Always assess central pain stimuli so it gets transmitted to the brain and you get a good idea of the patient's brain function.

Answer 223

Because the patient moving his arm upward to indicate a decoricate respond may be misinterpreted as a localization (withdraw of stimulus) of pain and hence this mix up can lead to errors in assessments. Basically because of confusion/ the fact that non-purposeful pain responses can be mistaken for purposeful. Also, some suggest applying the sternal rub for 30 seconds for accurate results but this may cause brusing and damage to the tissue. we don't want that.

Answer 224

-Snoring -Gurgling -Crowing -Stridor

Answer 225

A rough snoring sound on inspiration and/or exhalation

Answer 226

A sound similar to air rushing through water on inspiration and/or exhalation

Answer 227

A sound like a cawing crow on inspiration

Answer 228

Harsh, high pitched sound on inspiration

Answer 229

-If the patient exhibits any signs of poor profusion or shock a high concentration of oxygen should be administered -If spo2 is below 94%. First use NC at 2 LPM and titrate up to 6 and then switch to NRM if you can't achieve <94% SPO2 with NC

Answer 230

- if the patient exhibits any signs of major bleeding , poor perfusion or shock , a high concentration of oxygen should be administered via a NRM per minute , regardless of SPO2 - if there are no signs of major bleeding , poor profusion or shock , but the SPO2 is less than 95% percent on the initial reading or any time falls below 95% in trauma patient , a high concentration of oxygen should be administered via NRM

Answer 231

M:assive hemorrhage. control any bleeding, use hemostatic gauze if a torunique can't be applied. look for any evidence of missed bleeding especially to the neck, armpits, and groin. Assess A:irway. ensure patency and suction if needed and insert NPA/OPA If needed R:espirations. Assess rate and tidal volume. Begin BVM respirations if needed. Do not overventilate. An adult should only need 10 ventilations per minute. C:irculation. Double check your bleeding control and do a blood sweep with your hands checking the body for any other bleeding. Do shock preventative measures if needed. remember to apply a pelvis binder or wrap split if pelvic fracture is present since pelvis is a major source of bleeding. H:ypothermia. Hypothermia leads to ineffective clotting in the patient. remove wet clothing and place blankets on the patient. remove them from the environment. heat the back of the ambulance. Some H's in MARCH also include head injury. *MARCH is a mnemonic that is used to guide trauma assessment and care

Answer 232

Three conditions that lead to significant causes of death in trauma such as 1.Hypothermia 2.Hydrogen (increase in hydrogen leading to acidosis and inability of the body to carry O2) 3.Hypocoagulation (inability to clot effectively)

Answer 233

Peritonitis *Another abnormality in the abdomen is when it becomes distented because this requires an significant amount of blood. 2 liters of blood only raises the abdomen by 1 inch. *You may also want to note that a colostomy/ilostomy is a surgical opening the abdominal wall with a bag to hold excretions.

Answer 234

The abdominal aorta is weakened and bulging

Answer 235

When the patient can control and purposely guard his abdomen. Bypass it by making conversation or palpating with the stethoscope

Answer 236

Also known as the heel drop test is when you have the patient 1. if the patient can stand, have them stand on the balls of their heels 2. tell them to suddenly drop on their heels *Do the heel jar test if you are unable to do the heel drop test

Answer 237

If the patient complains of abdomen pain, this is a positive test for rebound tenderness, an indication of peritonitis or other inflammation within the abdomen such as appendicitis

Answer 238

1. Make a fist and strike the bottom of the patient's heel forcefully enough to jar the abdomen

Answer 239

Do not attempt to push the organs back in. Cover them with moist sterile dressing and seal them with a large occlusive dressing. *An evisceration is when organs, most commonly small intestines protrude from an open abdomen wound

Answer 240

It is a blood thinner. it keeps the coronary arteries from closing completely. we administer it for this effect and not the pain relief it provides. *We administer aspirin in the patient who has chest discomfort or pain that is or may be related to a inadequate amount of O2 getting to the heart (Acute Coronary syndrome)

Answer 241

A meter dose inhaler (MDI) or a small volume nebulizer (SVN). A MDI is quick to administer and an SVN allows the patient to inhale vapors over some minutes. *Most commonly these medications cause brochodilation but some patients may use non beta 2 medication, ipratropium bromide Atrovent, which blocks the Parasympathetic Nervous System stimulation of the bronchial muscle which prevents bronchoconstriction.

Answer 242

Asthma, emphysema, or chronic bronchitis

Answer 243

Place the medication in the specialized chamber and pass O2 or compressed air through to create a fine vapor.

Answer 244

spray or tablet. it also comes In a paste form but this form is not appropriate for the pre-hospital setting bcause of its unpredictable dosage, absorption and onset of actions

Answer 245

under the tongue (sublingually)

Answer 246

vasodilator. this in turn reduces the workload of the heart

Answer 247

hypotension. it decreases Systemic Vascular resistance, hence reducing blood pressure as identified in the formula: Cardiac output x Systemic Vascular Resistance = Blood Pressure *This is why it important to measure the blood pressure before AND after administration of nitro because of hypotension being the major side effect

Answer 248

Cardiac output x Systemic Vascular Resistance. therefore a a drop in systemic vascular resistance as seen with administration of nitro, there is a decrease of BP leading to hypotension

Answer 249

patients who take medication for erectile dysfunction in the past 24 hours. In particular, tadalafil (Cialis), vardenafil (levitra), or sidenafil (Viagra) because these are medications that lower BP. *The combination of the drop of blood pressure with nitro and the erectile dysfunction meds can cause severe decrease in BP and perfusion leading to death. however, some new research shows that maybe in some cases, nitro can be administered with caution but follow local protocols

Answer 250

-sublingual -oral -inhalation -intramuscular injection -intranasal -subcutaneous

Answer 251

the medication is placed under the patient's tongue to dissolve *Relatively rapid

Answer 252

-Nitroglycerin tablets -Nitroglycerin spray

Answer 253

The drug is taken by mouth (swallowed) EXCEPT for activated charcol which is typically absorbed *Has to go through the digestive system. For example, aspirin is typically chewed before being swallowed so that the medication absorption can begin immediately through the oral mucosa

Answer 254

-Aspirin -Oral glucose -Activated charcoal

Answer 255

The medication is prepared as a gas or aerosol and is then inhaled by the patient

Answer 256

-Oxygen -Meter-Dose Inhaler -Small-Volume Nebulizer

Answer 257

The drug is injected into muscle mass *relatively rapid absorbtion. Do not inject into vein as serious side effects may follow and only inject into specific muscle groups

Answer 258

-Epinephrine by auto-injector or manually via syringe and needle -Naloxone hydrocloride (Narcan) by auto injecter or manually via syringe and needle

Answer 259

the medication is sprayed into one or both nostrils use a special delivery device called a mucosal atomizer device (MAD) that is either attached to a syringe or to the device

Answer 260

The mad creates a fine spray that allows sticking and absorption by the nasal capillaries and squirting the medication inside allows for it to leak and fall out of the nose, rendering it ineffective.

Answer 261

-Narcan by syringe and MAD -Narcan nasal spray (one time use device)

Answer 262

It is injected under the skin into the subcutaneous layer *Slow absorption rate than intramuscular so it is not recommended for medications that require rapid absorption into the circulatory system such as epinephrine *Can be used after intramuscular injection of Narcan if you wish to produce prolonged effects of narcan

Answer 263

-Narcan by autoinjecter

Answer 264

-Compressed powder or tablet -Liquid (solution) for injection or intranasal administration -Gel -Suspension -Fine powder for inhalation -Small-volume nebulizer -Gas (O2 is the most common) -Spray

Answer 265

A compressed powder that is shaped into a small disk or elongated tablet

Answer 266

-Nitro tablets -Aspirin tablets

Answer 267

A liquid substance with no particulate matter

Answer 268

-Epinephrine that is injected -Narcan that is either injected or via MAD

Answer 269

A vicious (think, sticky) substance that the patient swallows

Answer 270

Oral glucose

Answer 271

Drug particles that are mixed in a suitable liquid; they do not stay mixed for a long time so you must shake prior to administration

Answer 272

Activated charcoal

Answer 273

A crystalline solid that is mixed with liquid to form a suspension, hence it is necessary to shake before administration *the medication appears as mist or aerosol, each dose delivers a precise measured amount of drug to the patient

Answer 274

Meter Dose Inhaler AKA MDI

Answer 275

A device that uses compressed gas, typically oxygen, that is forced into the chamber containing medication. The gas mixes with a liquid Solution and forms an aerosol, which is then inhaled by the patient through a mask or mouthpiece; the medication is directly deposited on the muscosual lining in the respiratory tract, meaning the effect is more immediate and there are less side effects. The package comes premeasured and premixed fixed container or inhaler.

Answer 276

Nitro, typically in tablet form but it can also come in spray form, simply spray it under the tongue

Answer 277

-inadequate volume -inadequate pump function -inadequate vessel tone

Answer 278

Stroke volume X HR *In a patient with inadequate blood volume, their stroke volume will fall and hence lead to a decrease in their preload which leads to a decrease in cardiac output which means cardiac output decreases

Answer 279

Decrease in blood volume = Decrease in preload = Decrease in stroke volume = Decrease of cardiac output = Decrease of systolic blood pressure = Decrease in tissue perfusion (because the blood pressure is responsible for delivering oxygenated blood throughout the body) = systemic vascular resistance and heart rate increase to compensate which leads to a decreased preload because the ventricle has less time to fill and it also leads to quicker organ death because the extreme vasoconstriction leads to an extreme decrease in end organ perfusion

Answer 280

-Red blood cells -White blood cells -Platelets -Plasma *A decrease in stroke volume can be front the loss of whole blood or just the loss of Plasma

Answer 281

Diarrhea, burns, excessive urination, capillary leakage, and excessive vomiting or sweating. They cause plasma volume loss through a shift in fulid.

Answer 282

-If the patient loses whole blood, there is a loss of O2 carrying capacity, in addition to the decrease in pressure and perfusion. The patient would benefit most from administration of whole blood or packed red blood cells and plasma, which would increase the oxygen carrying capability of the blood and improve pressure and profusion. *if only fluid is adminstered. The pressure and perfusion may improve but the patient would remain hypoxic because there are not enough red blood cells and hemoglobin to carry the O2. -If the patient is in shock from fluid depletion, They have enough red blood cells and hemoglobin to carry the O2 but the reduction in fulid has decreased the blood pressure and their ability to deliver O2 to the cells. Hence the patient would benefit most from restoration of fulid and water

Answer 283

If the heart doesn't have the strength to pump out the blood, this leads to a decrease of blood and glucose to the cells, hence a decrease in tissue perfusion

Answer 284

Damage to the heart- Myocardial infarction, other diseases, old age, injury, valvular diease, rhythm disturbances, CHF Mechanical obstruction of the movement of blood into the heart- when pericardial tamponade causes the heart chambers to become compressed or the other condtion that compresses the inferiro vena cava, tension pneumothorax because of the lungs puelral space filling with air), *remember, the inadequate pump function can occur from damage to to the heart or from an mechanical obstruction

Answer 285

With extreme vasodilation, systemic vascular resistance decreases, which decreases blood pressure, which decreases perfusion to the cells. The heart has a decreased preload because not enough blood is returning to it and this leads to decrease in preload, decrease in cardiac output, and hence a decrease in further blood pressure and perfusion.

Answer 286

-an injury to the spinal cord causes the sympathetic nervous system to stop stimulating the vessel, which regulates the vessel size -release of chemical mediators that causes systemic vasodilation

Answer 287

By restoring vessel tone with vasoconstriction or to fill the vessel with more fluid to increase the internal vessel pressure *both vasoconstriction and volume restoration are typically done at the same time *note that most shock treatment is beyond the scope of practice for an EMT but you must be able to recognize a shock state, provide rapid transport, and provides the appropriate emergency care. In some cases, you may want to contact ALS so they can administer medications, IV's, and other procedures in order to restore pressure, perfusion, cellular oxygenation, delivery of glucose, etc. Keep in mind though, ALS is limited (such as they only carry water based fluids and not packed blood) and you may worsen the patient's condition if you wait too long

Answer 288

-Hypovolemic -Distributive -Cardiogenic -Obstructive -metabolic/respiratory (only some sources list this category)

Answer 289

When you have low blood volume. It can be due to blood loss or loss of some other type of body fluid. The most common cause is hemorrhage. *the most common form of shock

Answer 290

A decrease in intravascular volume caused by massive systemic vasodilation and an increase in capillary permeability. With vasodilation, there is usually no actual loss of fluid or blood from the vessels , but rather a relative reduction in volume that is adequate to fill the increased size and capacity of the vessels. This leads to a decrease in blood pressure, a decrease in preload, a decrease in stroke volume, a decrease in cardiac output, a decresse in blood pressure, and overall, a decrease in perfusion *in some conditions, the capillaries become more permeable, leading to leakage and fluid loss

Answer 291

-Septic shock -Neurogenic shock -Anaphylatic shock

Answer 292

-Hemorrhagic shock -Non-hemorrhagic shock -Burn shock (a specific type of nonhemmoragic shock)

Answer 293

When the patient has adequate blood volume and vessel tone but inadequate pump function. The inadequate pump function leads to a decrease in stroke volume, cardiac output, blood pressure, and hence a decrease in perfusion. *the patient is prone to cardiogenic shock is they had 40% of their left ventricle deadened from myocardial infarction

Answer 294

-From Myocardial Infarction -Heart failure -From beta blockers / calcium channel blockers -From abnormal rhythm -Valvular disease -From decreased pump function

Answer 295

The blood volume is adequate and the heart is not damaged and the vessels are of normal size with adequate resistance , but an obstruction is not allowing the blood to move forward. This reduces preload, stroke volume, cardiac output, blood pressure, and hence decreases tissue perfusion. A common example of this display is pulmonary embolism. ☆THE BOOK MENTIONS PERICARDIAL TEMPONADE AND TENSION PNEUMOTHORAX AGAIN. these conditions prevent adequate ventricular filling and they compress the heart.

Answer 296

-From tension pneumothorax -From pulmonic embolism -From pericardial tamponade

Answer 297

A dysfunction in the ability of oxygen to diffuse into the blood, be carried by the hemoglobin, off-load at the cell or be used effectively by the cell for metabolism. Certain poisons produce this effect. For example, cyanide interferes with the cell's ability to use O2 and Carbon monoxide poisoning interferes with the hemoglobin ability to carry O2 because it replaces the O2

Answer 298

Disturbances in oxygen diffusion, carrying, off loading, or use by the cells

Answer 299

Results from the loss of whole blood from the intravascular space. Once whole blood is lost , there is not only decrease in perfusion from a reduction in pressure , but also a decrease in oxygen carrying capacity of the blood and hemoglobin.

Answer 300

1. Stop bleeding 2. Administer red blood cells and other components to replace the intravascular blood volume and clotting function that was lost * the patient requires immediate transport for surgical intervention to stop the bleeding

Answer 301

When fluid shifts out of the intravascular space , however , red blood cells and hemoglobin remain within the vessels , but it is primarily water plasma proteins and electrolytes that are lost. This reduces the blood volume pressure and perfusion of the cells, but the oxygen carrying capacity of the remaining blood is preserved. Examples include severe diarrhea, vomiting, excessive sweating, and excessive urination

Answer 302

Administration of IV fluids so call ALS if local protocols suggest so

Answer 303

Burns can interrupt the integrity of the capillaries and vessels and allow them to leak plasma proteins. Thus burns may disrupt the body's fluid balance. When the capillary is damaged from a burn, it becomes permeable and the push from hydrostatic pressure forces fluid out of the capillary and into the institial space. Plasma proteins have a pull effect so when they leak out, the plasma proteins that are outside of the vessel draws fluid out of the capillary. This leads to a collection of fluids causing edema and leads to a loss of fluids, causing Hypovolemic shock.

Answer 304

1. Establish and maintain an adequate airway , ventilation and oxygenation 2. Prevent further contamination of the burn injury * most burn patients die in the pre-hospital setting from airway obstruction, inadequate ventilation or toxic exposure. *also note burn shock takes several hours to occur

Answer 305

Chemical mediators that are released in the anaphylactic reaction cause massive systemic vasodilation. These chemical mediators also cause capillaries to become permeable and to leak. Vascular resistance decreases, resulting in a decrease in blood pressure and perfusion. The loss of fluid from the capillaries further reduces the intravascular volume, causing the preload to decrease, along with the decrease of , stroke volume, cardiac output, systolic blood pressure and perfusion to decrease.

Answer 306

Epinephrine. It contains alpha properties that cause systemic vasoconstriction, which reduces the vessel size and increases the resistance, resulting in an increase in blood pressure and profusion. In addition , the vasoconstruction tightens the capillaries and lessens the fluid leakage. *also remember to maintain airway management, ventilation, and Oxygenation

Answer 307

Resulting from sepsis that causes the vessels throughout the body to dilate and become permeable. Fluid leaks out of the vessels into the interstitial space. The shock state is created by the massive vasodilation, which reduces the systemic vascular resistance, blood pressure and perfusion. Also , the loss of fluid reduces the intravascular volume and decreases the preload, stroke volume, cardiac output, systolic blood pressure and perfusion. *defined as severe sepsis with hypotension (systolic blood pressure below 90)

Answer 308

The bodies exaggerated inflammatory response to an infection, typically fungal, viral or bacterial. It overwhelms the bodies normal defense and regulatory systems causing disruption in cell and organ function. *mortality rate for sepsis is 40%. With 60% of sepsis patients being geriatric. *sepsis is the 10th most common cause of death in the U.S

Answer 309

- Increased capillary permeability - Vasodilation - myocardial depression , which also leads to cardiogenic shock as well - alveolar/capillary membrane damage, allowing fluid to accumulate in the alveoli

Answer 310

- Tachycardia - Tachypnea - hyperthermia or hypothermia - hypotension *other signs and symptoms include flushed, warm skin (early), Mottled and cyanotic skin (late) and altered mental status

Answer 311

- productive cough - fever - chills - upper respiratory symptoms ( runny, or stuffed nose and sneezing) - throat or ear pain - crackles upon auscultation (may indicate pneumonia)

Answer 312

- abdominal pain or flank tenderness - nausea and vomiting - diarrhea - dysuria - polyuria

Answer 313

You will focus on managing the airway, ventilation and oxygenation, but the patient would benefit from IVs, vasoconstrictors and antibiotics, so call ALS

Answer 314

Also known as vasaogenic shock, is when you damage your spinal cord which damages the sympathetic nerve fibers that control vessel tone BELOW the level of injury. Loss of sympathetic tone causes the vessels to dilate. This can lead to a drop in systemic vascular resistance, blood pressure and perfusion. However, in this condition, there is no fluid loss. The drop in perfusion is sloely from widespread vasodilation , blood begins to pool in the peripheral vessels , causing a decrease in the preload, stroke volume, cardiac output and systolic blood pressure , causing a further decrease in perfusion.

Answer 315

Emergency care focuses on spine motion restriction and management of the airway, ventilation and oxygenation. This patient may also benefit from IVs and vasoconstrictors so consider calling ALS.

Answer 316

It is both a category and a type of shock. It is most often due to an acute myocardial infarction, congestive heart failure, abnormal cardiac rhythm, disease, infection or overdose on drugs that depress the pumping function of the heart, such as beta-blockers or calcium channel blockers. The depressed pump function reduces the force on the left ventricle contraction, reducing stroke volume, cardiac output, Systolic blood pressure and perfusion.

Answer 317

By managing the airway, ventilation and oxygenation. The patient may benefit from intervention and medication to administered by ALS.

Answer 318

Their blood vessels constrict very efficiently, which helps to maintain blood pressure. But only for so long , when adverse conditions are not corrected in a timely fashion and the conditions leading to shock continue.The blood pressure eventually drops and it normally occurs rapidly and eventually precipitates cardiac arrest. Children have great compensary mechanisms , but they decompensate rapidly once overwhelmed. * note that cardiac pulmonary arrest is typically due to either respiratory failure or shock. *Children cannot alter their cardiac output much and thus are very dependent on increasing pulse

Answer 319

Loss of body heat because they have immature thermal regulatory systems and cannot shiver or warm themselves through muscular activity. Their skin surface area is large in relation to their body weight , which increases their rate of heat loss.

Answer 320

1. Control any bleeding 2. Establish and maintain an airway (maintain a SPO2 above a 95% with NRM 15LPM) 3. If the breathing is or becomes inadequate , begin positive pressure ventilation 4. Place the patient in a supine position 5. Keep the patient warm and as calm as possible ( if the patient is a newborn, preheat an isolette or your ambulance to at least 98⁰ (36.5⁰c) if you cannot do this, wrap the baby in warm blankets (pre warmed if possible) And then wrap the baby in aluminum foil to preserve the bodies heat. be sure that the baby's head is covered but not the face 6. Transport

Answer 321

Oxygen and ventilation, it is also imperative that the pregnant patient in cardiac arrest be transported immediately to a medical facility because the fetus requires a c section within 5-6 minutes to survive. *Maternal cardiac arrest can occur due to a number of reasons such as hemorrhage, cardiovascular disease, amniotic fluid, embolism, sepsis, aspiration pneumonitis, pulmonary embolism or eclamsia.

Answer 322

The weight of the fetus can compress the inferior vena cava when the patient is in a supine position. This causes a decrease in blood return to the right ventricle, and a decrease in blood pressure. If the patient is in cardiac arrest, this decrease in blood return significantly decreases the effectiveness of chest compressions and the arterial pressure needed to perfuse the brain and the heart.

Answer 323

We can palpate the location of the top of the uterus (the fundus). If the height of the fundus is at or above the level of the umbilicus , the pregnant patient you would estimate the fetal gestational age to be at or greater than 20 weeks. The older the fetus , the higher the fundus is located towards the xiphoid process.

Answer 324

One-handed technique: position yourself on the right side of the patient and take your extended right hand and place it on the lateral aspect of the abdomen at and just below the umbilicus and manually push the uterus to the left Two-handed technique: position yourself on the left side of the patient and take both of your hands and place them on the right lateral aspect of the abdomen with a hands extended and the tips of the fingers of both hands, touching and forming a sort of cradle with the umbilicus in the center and manually pull the uterus toward you to the left side of the patient. *You must maintain LUD the whole time when you are performing compressions. If a pulse returns and chest compressions are no longer needed, the right hip can be elevated to take the weight off the inferior vena cava. Should cardiac arrest occur again, move her back into the supine position and resume LUD with compressions

Answer 325

A permanent disease process distal to the terminal bronchioles that is characterized by the destruction of the alveolar walls and the distention of the alveolar sacs and a gradual destruction of the pulmonary capillary beds with a severe reduction in the alveolar/capillary area in which gas exchange can occur. * it is more common in men than in women , and it is most often seen in people aged 60-70.

Answer 326

1. Smoking 2. A genetically triggered decrease in the protein called alpha 1 antitrypsin. This genetic emphysema can occur in people 40-50 years old. *people who are continuously exposed to environmental toxins are predisposed to developing emphysema

Answer 327

The lung tissue loses its elasticity and the alveoli becomes distended with trapped air and the walls of the alveoli are destroyed. This loss of the alveolar wall reduces the surface area in contact with pulmonary capillaries. Therefore , a drastic disruption in gas exchange occurs and the patient becomes progressively hypoxic (COPD) and begins to retain carbon dioxide.

Answer 328

- anxious, alert and oriented - dyspneic - USES ACCESSORY MUSCLES (because breathing becomes an active process) - THIN BARREL CHEST APPEARANCE (from chronic air trapped in the alveoli) - coughing but with little sputum - prolonged exhalation (due to loss of elasticity of lungs) - diminished breath sounds - wheezing and rhonchi on auscultation - PURSED-LIP BREATHING (physiologic Positive End-Expiratory Pressure (PEEP) because breathing is difficult for the patient so they create a back pressure in the distal bronchioles , keeping them more open than if they didn't purse their lips) - extreme difficulty of breathing on minimal excertion -TACHYPNEA - typically greater than 20 BPM (to compensate for the disease process) -Tachycardia - Diaphoresis (sweating; moist skin) -SPO2 of 94% or greater unless in respiratory failure -Tripod position - May be on home oxygen

Answer 329

When an obstruction of blood flow in the pulmonary arteries leads to hypoxia

Answer 330

- patients with long periods of immobility (bedridden, those who travel for a long time, or with splits to the extremities) - heart disease - recent surgery - long bone fracture patients - venous pooling associated with pregnancy - cancer - deep vein thrombosis - estrogen therapy - clotting disorders - history of previous pulmonary embolisms - those who smoke

Answer 331

A sudden blockage of blood flow through a pulmonary artery or one of its branches. The embolism is usually caused by a blood clot, but it can also be caused by an air bubble, a fat particle, a foreign body or amniotic fluid. The embolism prevents blood from flowing to the lungs. As a result , some areas of the lungs have oxygen in the aveoli (adequate ventilation) but are not receiving any blood flow (reduced perfusion). This leads to hypoxia , based on how large the embolism blocking the arteries is, the larger ones leading a decreased severity of hypoxia.

Answer 332

Pulmonary embolism

Answer 333

- SUDDEN ONSET OF UNEXPLAINED DYSPNEA - signs of difficulty in breathing or respiratory distress; rapid breathing - SUDDEN ONSET OF SHARP STABBING CHEST PAIN, PREDOMINANTLY DURING INHALATION - cough (may include blood) - tachypnea - tachycardia - syncope - cool, moist skin - restlessness, anxiety or sense of doom - cyanosis (might be severe/late sign) - distended neck veins (late sign) - crackles - fever - SPO2 less than 94% - signs of complete circulatory collapse - NO ABNORMAL BREATH SOUNDS AND ADEQUATE VOLUME *assess for deep vein thrombosis for patients in which you suspect pulmonary embolism

Answer 334

1. Open the airway and initiate positive pressure ventilation with supplemental oxygen or administer oxygen to maintain a SPO2 of 94% or greater 2. Continuously monitor the patient for signs of respiratory failure , respiratory arrest , hypotension , poor perfusion , and cardiac arrest 3. Transport

Answer 335

Cardiogenic and noncardiogenic

Answer 336

It is typically related to an inadequate pumping function left ventricle. It drastically increases the pressure in the pulmonary capillaries, forcing fluid to leak into the space between the alveoli and capillaries and eventually into the alveoli

Answer 337

Also known as acute respiratory distress syndrome (ARDS) results from destruction of the capillary bed that allows fluid to leak out. * common causes of noncardiogenic pulmonary edema are severe pneumonia, aspiration of vomitus, submersion, narcotic overdose, inhalation of smoke or other toxic gases, ascent to high altitudes, sepsis and trauma. * the most significant problem associated with pulmonary edema is hypoxia

Answer 338

Typically caused by cardiogenic ethiology occurs when an excessive amount of fluid collects in the spaces between the alveoli and the capillaries. This intrusion of fluid disrupts normal gas exchange which makes less oxygen available to the blood flowing through the capillaries (perfusion). This leads to hypoxemia and cellular hypoxia. The offloading of carbon dioxide from the capillaries into the alveoli is also impended, leading to hypercarbia.

Answer 339

- dyspnea, especially on exertion - difficulty in braving when lane flat (ORTHOPNEA) - waking up suddenly short breath ( PAROXYSMAL NOCTURNAL DYSPNEA (PND)) - PINK AND OR FROTHY SPUTUM (only cardiogenic type) - tachycardia - anxiety, apprehension, combativeness and confusion - tripod position with legs dangling - fatigue - CRACKLES AND POSSIBLY WHEEZING ON AUSCULTATION - cyanosis or dusky-colored skin - pale, moist skin - distended neck veins (cardiogenic type only) - swollen lower extremities (cardiogenic type only) - cough - fever - symptoms of cardiac compromise - SPO2 less than 94%

Answer 340

1. If there's any evidence of inadequate breathing , you need to begin PPV with a BVM and provide supplemental oxygen 2. CPAP can be extremely beneficial in the acute pulmonary edema , patient in respiratory distess or early respiratory failure but they MUST be awake, alert, oriented, be able to follow commands (GCS needs to be greater than a 10) breathe on their own, maintain their own airway, and have a SPO2 less than 94%). The positive pressure forces the oxygen across the alveoli and into the capillaries *if patient doesn't fit criteria for CPAP, do BVM *keep the patient in the upright sitting positon and transport

Answer 341

-how hard they're working to breathe - their appearance - their circulation

Answer 342

- flared nostrils - retractions - abnormal sounds (stirdor, grunting, wheezing) - abnormal positioning (sniffing, tripod, refusal to lie down) - head bobbing

Answer 343

- irritable - inconsolable - gaze - decreased muscle tone

Answer 344

- cyanosis - pale - mottled

Answer 345

A symptom commonly associated with coronary artery disease. It means pain in the chest. There is classic angina, which typically occurs upon an increased workload placed on the heart, and there's unstable angina, which indicates angina discomfort that is prolonged and worsening or that occurs without exertion and when the patients at rest.

Answer 346

It is a symptom of inadequate oxygen supply to the heart muscle or myocardium. As noted earlier , it typically results from a decrease in oxygen delivered to the myocardium , which is often caused by partial blockage of the coronary arteries , causing ischemia, which results in tissue hypoxia. Angina can also occur from a dramatic increase in demand on the heart , such as from a cocaine induced myocardial infarction.

Answer 347

- study discomfort, usually located in the center of the chest but it can be more diffuse throughout the front of the chest - DISCOMFORT , THAT IS USUALLY DESCRIBED AS pressure, SQEEZING, TIGHTNESS, aching, CRUSHING OR heavy - DISCOMFORT THAT IS TYPICALLY FELT UNDER THE STERNUM AND MIGHT RADIATE TO THE SHOULDERS , ARMS , NECK , JAW , BACK OR EPIGASTRIC REGION - cool, clammy skin - anxiety - dyspnea (Shortness of breath) - diaphoresis (excessive sweating) - Nausea and vomiting - complaint of indigestion pain * the pain typically lasts for 2-15 for classic agina

Answer 348

The discomfort can appear to be more diffuse or can be described more vaguely. These patients might not have any chest pain or discomfort , but might instead complain of epigastric pain , shortness of breath , nausea , fainting , weakness or lightheadedness

Answer 349

Classic: - typically relieved with rest and nitroglycerin * if classic angina following exertion is not relieved after rest or after three nitroglycerin tablets or sprays over a 10 minute period you should recognize this as an acute coronary syndrome emergency and provide transportation and treatment immediately Unstable: - pain or discomfort that occurs at rest - pain that continues without relief - prolonged pain *if the patient experiences angina that occurs at rest and lasts for more than 20 minutes, angina with a recent onset that progressively worsens or angina that wakes up the patient and night (nocturnal angina) You should view it as a cute coronary syndrome emergency and provide prompt treatment and transport

Answer 350

1. Establish an open airway 2. If the patients respirations become inadequate, begin PP 3. If the patient is dyspneic or hypoxemic, has obvious signs of heart failure or has an SPO2 below 90%, and minister supplemental oxygen to reach an SPO2 of 90%. Use NC at first 2-6 titrate upward and then NRM 10-15. 3. Administer nitro IF thier systolic blood pressure is greater than 90mmHg. Place them in a sitting or lying position and administer the nitro tablets or sprays. ( if you patient is suspected of suffering a coronary artery occlusion, administer 160-325 mg of aspirin if local protocol allows) * the american heart association 2020 guidelines for cardiopulmonary resuscitation and emergency care for cardiovascular care continues to indicate that there is not sufficient evidence to support the routine use of supplemental oxygen in patients who do not present with dyspnea, hypoxemic, or heart failure. ADMINISTERING TOO MUCH OXYGEN IN ACUTE CORONARY SYNDROME CAN CREATE FREE RADICALS

Answer 351

When a portion of the heart muscle dies because of the lack of adequate supply of oxygenated blood.

Answer 352

It is typically the result of a coronary artery disease that causes severe narrowing or complete blockage of the coronary arteries. For example a plaque, erosion or rupture within the coronary artery can cause narrowing and blockage to occur. The result is a portion of the heart muscle does not receive adequate oxygenation and approximately 20-30 minutes without adequate perfusion , the heart muscle begins to die. * on rare occasions , a heart attack can result from a spasm with a coronary artery such as use of cocanine

Answer 353

If the blood flow is not restored to the portion of the heart, the cells begin to die and the ischemic heart tissue can become irritable. This can produce dysrhythmias, such as ventricular fibrillation , and ventricular tachycardia, which can be fatal. *V-Fib is the most common dysrhythmia the patient will suffer initially in cardiac arrest, and it usually occurs within the 1st hour after the onset of S/S but the patient remains at risk for the first 24 hours.

Answer 354

- CHEST DISCOMFORT , RADIATING TO THE JAWS , ARMS, SHOULDERS OR BACK - anxiety - dyspnea - SENSE OF IMPENDING DOOM - diaphoresis (sweating) - nausea and vomiting - light headedness or dizziness - weakness - PROLONGED CHEST DISCOMFORT - CHEST DISCOMFORT THAT IS PARTIALLY OR IS NOT RELIEVED AT ALL WITH NITROGLYCERIN *super similar to unstable angina

Answer 355

They may suffer a silent "MI" in which no chest discomfort is experienced but rather , they might only complain of shortness of breath , nausea , lightheadedness or weakness

Answer 356

1. This patient has the potential to go into cardiac arrest. Therefore, you should maintain a vigilant watch over the patient's condition. If possible , the patient should never be left alone. The automated external defibrillator (AED) must always be available for the patient. Some services even apply the AED pads without connecting it to the AED as a precaution to save time. 2. ensure a patent airway and provide PPV with oxygen if the breathing is inadequate. If the respiratory rate and tidal volume are both adequate , consider supplemental oxygen. Reach a SPO2 of 90%, start with NC 2-6 titrating up and then go to NRM 10-15 3. Place the patient in a position of comfort 4. If the patient has a prescription for nitroglycerin and administer one tablet every 3-5 minutes up to a total of 3 times. Ensure that the systolic blood pressure is above 90 mmHg 5. Administer 160-325 mg of aspirin if local protocol allows 6. notify the receiving hospital early of suspected myocardial infarctions 7. Acquire and transmit a 12 lead ECG if your protocol permits 8. continue to assess the patient en route to the Medical Facility and contact ALS for further Assistance if available * with the availability of techniques to restablish blood flow in the coroner artery by mechanically increasing the internal lumen size and medications called fibrinoytic agents. It might be possible to dissolve the clot, reopen the coronary artery and restore perfusions to the ischemic heart muscle, prompt recognition and transport is necessary because the window of time to mechanically open the vessel or to administer the fibinolytic drug is limited.

Answer 357

Because in acute coronary syndrome, the coronary artery is occluded and cuts off blood supply to the heart tissue.This area of tissue becomes a ischemic from the lack of oxygenated blood and during this period, if you administer too much oxygen, there's an inflammatory response and the release of damaging molecules made from oxygen , which are referred to as FREE RADICALS. * administration of too much oxygen also causes the coronary arteries to constrict , which in turn causes a decrease in the blood flow to the area of ischemic tissue ( THIS IS WHY THE IDEAL SPO2 IS 90% IN A ACUTE CORANARY SYNDROME PATIENT) ( ADMINISTER O2 USING STARTING WITH A NC AT 2-6 LPM TITRATING UP AND SWITCH TO NRM 10-15 IF SPO2 OF 90% CANNOT BE ACHIEVED VIA NC)

Answer 358

When you restore blood flow to an ischemic area and create free radicals , which damage cell membranes and other cellular components, and result in cell death. *Reperfusion is the restoration of blood to an area of tissue that was ischemic from low blood flow or occlusion of a vessel

Answer 359

- the patient exhibits signs and symptoms of chest pain or discomfort, consistent with acute coronary syndrome - the patient has a physician prescribed nitroglycerin , or it is carried on the EMT unit - the EMT has received approval from medical direction to adminsiter the medication

Answer 360

- the patient's baseline systolic blood pressure is below 90 mmHg or the systolic blood pressure has decreased greater than 30 mmHg from the baseline - the heart rate is less than 50 BPM or greater than 100 BPM - the patient has a suspected head injury - the patient is an infant or child - 3 doses have already been taken by the patient - the patient has taken erectile dysfunction pills tadalafil (Cialis) within the past 48 hours or vardenafill (Levita) or sildenafil (Viagra) within the past 24 hours

Answer 361

Either one tablet (0.3 mg) or one spray (0.4 mg) under the tongue. The administer dose may be repeated every 3-5 if: 1) the patient experiences no relief 2) the blood pressure remains greater than 90 mmHg or does not fall 30 mmHg below the baseline systolic blood pressure 3) the heart rate remains above 50 BPM and below 100 BPM 4) medical direction gives approval * the total dose is 3 tablets for sprays

Answer 362

-headache -a drop in blood pressure - changes in pulse rate as the body compensates for changes in the blood vessel size

Answer 363

- reticular activating system - at least one cerebral hemisphere must be intact

Answer 364

-brain tumor -hemorrhage in the cranium but outside of the brain -hemorrhage in the brain tissue -direct brain tissue damage from trauma to the brain -degenerative disease of brain -brain abbesses or infection

Answer 365

-severe hypoxia or anoxia (reduced or no O2) - Abnormal GBL (high or low) -Liver failure -Kidney failure -Poisoning

Answer 366

-shock -drugs that depress the CNS -Post seizure -Infection -Cardiac rhythm disturbance -Stroke

Answer 367

87% of all strokes and there are two types, thrombotic stroke (clots at the site) and embolism stroke (clots at a different site)

Answer 368

13% of all strokes, and there are two primary causes, an aneurysm (ballooning of a weakened area within the artery) or an arteriovenous malformation (abnormally formed blood vessels in the brain). it is a rupture of a weakened artery that causes bleeding in the brain.

Answer 369

-Headache -Nausea and vomiting -Weakness to one of the body -Decreased levels of consciousness

Answer 370

-worst headache -intolerance to light -vomiting -decreased LOC's

Answer 371

It does but it must always be taken seriously because it is typically a precursor to a stroke. 15% of TIA's lead to a stroke in the following 90 days *Most last less than 5 minutes, and the S/S typically clear up in a few minutes but most resolve within 60 minutes. Some may last for up to 24 hours.

Answer 372

-Paralysis and motor deficiencies (unilateral) -Numbness, tingling, and loss of sensation -Language disturbance (expressive aphasia, receptive, or global) -vision disturbance (could be loss of partial or complete vision and it's like a curtain or fog, eye movements remain normal) -Eye gaze (conjugate eyes, both eyes are together toward the side of the brain with the clot)

Answer 373

Expressive: they understand but they can't formulate their words receptive: they don't understand but they can formulate their words global: they don't understand or speak right

Answer 374

-Paralysis and motor deficiencies (unilateral) -Numbness, tingling, and loss of sensation -Language disturbance (more slurred and difficult to understand speech due to facial paralysis) -vision disturbance (complaints of double vision (diolopia) or bouncing of vision.) -Eye gaze (dysconjugate eyes, eyes look away from each other) -Ataxia (loss of coordination) and vertigo -Dizziness, nausea, and vomiting

Answer 375

-a continuous seizure actively lasting longer than 5 minutes -two or more sequential seizures without full recovery between seizures

Answer 376

-Generalized convulsive status epilepticus with a persistent postical depression mental status between seizures -Non convulsive seizures that produce a continuous or fluctuating epileptic twilight state -Repeated partial seizures with focol motor signs, focal sensory defects or focal impaired function, not assocted with alerted awarenss

Answer 377

-aspiration -brain cell damage from hypoxia and lack of glucose -Rhabdomyolysis (muscle damage with the release of proteins that can damage the kidneys) -fractures or dislocations

Answer 378

-increase the movement of glucose out of blood into the cells -causes the liver to take glucose out of the blood and convert it into glycogen -decreases GBL by actions just listed *if insulin is inadequate, glucose moves into the cell 10x slower, causing glucose build up in the blood

Answer 379

No, but be careful because glucose is the only energy source for the brain

Answer 380

A condition in which there is a disturbance in the metabolism in carbohydrates, fats, and proteins *The two primary problems in this condition is a lack of insulin secreted by the pancreas and the inability of the cell receptors to recognize insulin and allow glucose to enter at a normal rate

Answer 381

-Type 1 -Type 2 -DKA -Hyperglycemic hypoersmolar syndrome (HHS)

Answer 382

When the patient's pancreas cannot secrete insulin. *more common in young fresh meat

Answer 383

When your bodies receptors don't recognize insulin

Answer 384

25% of HHS patient suffer from type 1 diabetes and 75% suffer from type 2 and it is more common in white folk. Remember it is more common in type 2. It raises the GBL to extreme levels such as 700-1200 mg/dl but it does not produce ketones because some glucose is still getting into the cells.

Answer 385

Most common in type 1 patients. Blood glucose is greater than 250 and ketones are produced, making the body acidic. *The two main probelms It creates is dehydration and acidosis *Glucose pulls water and as we piss, it gets dragged out *The body metabolizes fats for energy, creating ketones

Answer 386

-AMS -History of diabetes -GBL less than 70 mg/dl -Ability to swallow the medication *Common other names oral glucose glutose and insta-glucose

Answer 387

-unresponsive or unable to swallow -A confirmed GBL of 70 or above

Answer 388

1.get permission from medical direction 2. ensure S/S are consistent with hypoglycemia, if protocol allows, get a GBL reading 3. ensure patient is responsive and able to swallow and able to protect their airway. Maintain watch of patient's airway to make sure it stays patent and they do not aspirate or have a blocked airway due to the glucose 4. There are two ways to administer. 1. hold back the patient's cheek and squeeze a small amount of glucose between the cheek and gum 2. place a small amount of glucose on a tongue depresor (a stick), pull back the check and slide the tongue depressor to administer medication between the cheeks and the gums

Answer 389

The three P's -Polyuria -Polyphagia (hunger) -Polydispsia (thrist) -nausea and vomiting -tachycardia -kussmual breathing -Fruity breath -BGL greater than 250 -Abdominal pain *When treating diabetes, err to the side of administering glucose if you are unsure if it is hypoglycemia or hyperglycemia

Answer 390

1. establish and maintain a patient airway 2. maintain adequate oxygen greater than 94% use NC 2-6 LPM titrate up and switch to NRM 10-15 LPM if NC don't work 3. if breathing is inadequate, provide PPV 4. determine the BGL 5. If BGL is less than 70, adminster oral glucose if patient can swallow 6. contact medical direction for further orders

Answer 391

-Maintain a patent airway (use a PPV to ventilate the patient because their airway might be swollen, it would be more difficult with a BVM) -Suction any secretions -Maintain adequate oxygenation, greater than 94%, USE NRM because NC cannot provide adequate oxygenation unless in a less severe patient -be prepared to assist ventilations -ADMINISTER EPINEPHRINE -Consider calling ALS -Initiate early transport

Answer 392

A1- vasoconstriction A2 - regulates A1 B1 - Increases HR and force of contraction B2 - Brochodilation

Answer 393

0.30 mg for patients who weigh 66 lbs or greater 0.15 for infants and children 33-66 lbs *The dose can be repeated in 5-15 minutes if the condition does not improve *it is preferable to inject in the site with minimal clothing, into the thigh

Answer 394

Any natural , synthetic or semisynthetic agent that mimics the effects of morphine *opiate is a term for drugs that come from opium, narcotics are drugs that put you to sleep, therefore, opioid is an umbrella term for drugs

Answer 395

-CNS depression -respirarory depression -miosis (constricted pupils) Other S/S may include: - seizure - psycho motor delay and disabilities - dysarthira (speech disturbance) - ataxia (incoordination) - tremors - crackles - hearing loss - hypotension - bradycardia - nausea and vomiting - urinary retention - itching, flushing and hives - hypoglycemia - hypothermia

Answer 396

1. Establish and maintain an open airway 2. Assess the breathing status 3. Maintain adequate oxygenation above 94% 4. Administer narcan 5. Transport 6. Reassess for deterioration

Answer 397

One of several viruses that directly affect the liver, it can be contracted through blood and body fluids *vaccine available

Answer 398

- fatigue - nausea and loss of appetite - abdominal pain - headache - fever - jaundice - dark urine

Answer 399

The most common bloodborne infection in the united states , it is also a virus. *vaccine NOT available

Answer 400

- jaundice - fatigue - abdominal pain - nausea - dark urine - loss of appetite

Answer 401

- wear disposable protective gloves - wash your hands, wrist, and forearms throughly with hot soapy water - get vaccinated - double bag and seal all soil refuse dispose of it - clean, disinfect or sterilize all non disposable equipment

Answer 402

- fever - cough ( often coughing up blood) - night sweats - weight loss * tuberculosis was almost extinct , but made a dramatic comeback

Answer 403

- wear a HEPA or N95 mask - perform artificial ventilation with OSHA approved equipment - wash your hands thoroughly - disinfect all non disposable equipment

Answer 404

-visceral -parietal (also known as somatic pain) -referred pain

Answer 405

When an abdominal organ is involved. Most organs do not have highly sensitive nerve fibers. Therefore , visceral pain is usually less severe and poorly localized. This type of pain is dull and aching , and can be constant or intermittent.

Answer 406

Also known somatic pain, is associated with the irritation of the peritoneoum lining. This lining has a larger number of highly sunsed nerve endings. Thus , you would expect pain to be more severe and more localized. This pain can be intense , found on one side, sharp and typically constant.

Answer 407

It is visceral pain, pain from an organ that is not felt in the organ itself but instead is felt elsewhere in the body. The pain is usually poorly localized, but is felt consistently in the part of the body it is referred to. Referred pain occurs when organ share a nerve pathway with a skin sensory nerve and the brain is confused and interprets the pain elsewhere.

Answer 408

Irritation and inflammation of the peritoneum. It occurs when blood, pus, bacteria or chemical substances leak into the peritoneal cavity.

Answer 409

When the EMT would push slowly down on a quadrant of the abdomen to slightly compress the tissues beneath and then suddenly release the pressure. When the abdomen contents resume their original position, the peritoneal surfaces rub together. If there is inflammation to the peritoneal linings , it elicits pain, this technique , however , has fallen into disfavor because the patient with abdominal pain could be overdoing it or extremely frightening of someone pushing on his abdomen, and in either case, fail to be objective. *replaced by the markle test

Answer 410

Inflammation of the appendix that commonly causes an acute adomen, it is usually caused by a blockage and the intestines and results in inflammation and irritation. If left untreated , inflammation eventually causes the tissue to die and rupture

Answer 411

Inflammation of the pancreas that can cause severe pain in the middle of the upper quadrants. This abdominal pain sometimes radiates to mid to lower back. It can be triggered by a variety of causes including the ingestion of alcohol, gallstones or infection. complications that result from pancreatitis include absesses, sepsis, hemorrhage, tissue death, hypoglycemia, or hyperglycemia and organ failure.

Answer 412

Inflammation, the gallbladder. In some cases, the gallstones actually block the opening of the gallbladder to the small intestine. This blockage causes an increase in pressure inside the gallbladder, which causes distension and severe pain. Definitive care for this condition is hospitalization and sometimes surgical intervention to remove the gallbladder stones or blockage. * more common in females than males and frequently occurs between the ages of 30-50

Answer 413

Upper GI bleeding is frequently caused by peptic ulcers ,gastric erosion, and varices. Lower GI bleeding is caused by diverticulitis, arteriovenous malformations, or tumors. Upper=more common in men Lower=more common in gals

Answer 414

- hematemesis (vomiting blood) - hematochezia (red blood in the stool) - melena (dary stool) - AMS - tachycardia - pale, cool, and clammy skin -abdominal pain or tenderness

Answer 415

Bulging, engorgement or weakening of the blood vessels in the lining of the lower part of the esophagus. Common with heavy alcohol drinkers or patients with liver disease , it is caused by an increased pressure in the venous blood supply of the liver.

Answer 416

- vomiting blood - ABSENCE of pain or tenderness - rapid pulse - difficulty breathing - pale, cool, Clammy skin - S/S of shock - jaundice

Answer 417

Open wounds or sores within the digestive tract, they are associated with a breakdown of the lining that normally protects the intestines from the digestive fluids contained inside a digestive tract. This break down can cause damage to the stomach or intestines, and in some instances, massive bleeding.

Answer 418

- gradual onset of abdominal pain, normally , in the lower quadrant and epigastrous region and described as burning or gnawing - nausea and vomiting - hematesis (vomiting blood), hematochezia (blood in stool), and melena (dark stool) - S/S of shock - pertionitis

Answer 419

A blockage that interrupts normal flow of the intestinal contents within the intestines. Blockages occurring in the small intensive are usually the result of adhesions (the intestines sides sticking together), gallstones, or hernia. blockages of the large intestine are caused by tumors , adhesions , twisting of the bowel or fecal impaction

Answer 420

- abdominal pain - nausea and vomiting - obstipation (difficulty in passing stool) - abdominal distention and tenderness - abnormally prominent high pitched bowel sounds

Answer 421

Protrusion or thrusting forward of a portion of intestine through an opening or weakness in the abdominal wall.

Answer 422

- sudeen onset of abdominal pain - fever - rapid pulse - tender mass at point of hernia - other similar to intestinal obstruction

Answer 423

AAA: Balloning and weakening of a the wall of the abdominal aorta AD: rupture or tear of the abdominal wall of the aorta

Answer 424

- gradual onset of lower lumbar, groin , and abdominal pain - rupture associated with sudden onset of severe constant abdominal pain , which can radiate to the lower back , flank or pelvis - testicular pain in the male patient - molted or spotty abdominal skin - pale, cool, clammy and possibly cyanotic skin in the legs due to decreased perfusion - absent or decrease femoral or pedo pulses - if abdomen is soft, you may be able to feel a pulsating mass but if there is a rupture, the abdomen will be rigid and tender - if the AAA is starting to rupture, the skin below the waistline can become cyanotic, cold, and Mottled *DO NOT PALPLATE AN AAA PATIENT, IT CAN CAUSE RUPTURE

Answer 425

1. Keep the airway patent. You might need to place patient in recovery positon to prepare for vomitus 2. Please the patient in position of comfort 3. Begin PPV if breathing is inadequate, 10-12 BPM 4. If breathing is adequate maintain oxygenation (greater than 94%) 5. Never give anything by mouth 6. Calm and reassure the patient 7. Treat for shock if S/S of hypoperfusion are present 8. Initiate a quick transport

Answer 426

Period pain. It is typically caused by hormonal imbalances or other conditions.

Answer 427

When a patient experiences abdominal pelvic pain in the middle of her menstrual cycle , it is caused by irritation of the peritoneoum by the small amount of bleeding associated with the rupture of the ovarian tissue that occurs with the release of the mature ovum.

Answer 428

An infection of the female reproductive track. pelvic infections are caused by bacteria, fungi or viruses. this condition is commonly spread during sex, but it can also spread from the result of a gyneological procedure insertion of A IUD device, childbirth or an abortion. *SEX SEX SEX JUST REMEMBER BE SAFE WITH YOUR SEXUAL ACTIVITES

Answer 429

- abdominal pelvic pain or tenderness - vaginal discharge with an abnormal color, consistency or odor - fever and chills - anorexia - naseua or vomiting - inrregular vagina bleeding or cramping - pain during intercourse

Answer 430

Also known as kidney stones, are crystals of substances such as calcium, uric acid, struvite, and crystine that are formed during metabolic abnormalities. Risk factors include family history, hyperparathyroids, recurrent UTI's, sedentary lifestyle, dehydration and obesity. Kidney stones are believed to originate in the kidneys and must pass through the rest of the urinary system to be eliminated. Severe pain can occur with this process, especially the Stone is large and passing through a ureter. if left untreated renal calculi can lead to loss of kidney function or kidney damage. the recurrence of kidney stones is common and can occur up to 50% of the patients who have had them.

Answer 431

- abdominopelvic pain or tenderness - flank , or back pain that is colicky and severe - groin pain - abnormal urine color - pain with urination - frequent or urgent need to urinate - fever or chills - nausea or vomiting

Answer 432

An artificial process to remove water and waste substances from the blood when the kidneys fail to function properly.

Answer 433

Hemodialysis: a dialysis machine containing the dialysate is connected to an access site on the patient. The access site can be a shunt, fistula, port or graft. The patient's blood is pumped through the access site and into the machine to have waste removed. The EMT should not take the blood pressure of a dialysis patient on the side of the patient's access site Peritoneal dialysis: The dialysate is run through a tube into the patient's abdomen. The fluid remains in the abdomen for several hours so that it could absorb the waste and then it is drained out of the body through a different tube. This is commonly performed at home and less common.

Answer 434

1. Maintain ABC's 2. Support ventilation as needed 3. Provide high concentration oxygen 4. Stop any bleeding from the shunt or access site 5. Position the patient. (In a shock patient, place them supine and in pulmonary edema, place them upright) 6. Transport

Answer 435

- ambiemt temperature, wind chill and moisture (winds can cause hypothermia in chill but not necessarily cold temperatures) - age (infants have a large surface area in relation to their overall size and cannot shiver. Both the young and old have less body fat. Elders have impairment of cold recognition, diminished basel metabolism, and poor constriction - medical conditions (surgery, shock, head injury, burns, infection, spinal cord injury, diabetes, thyroid gland disorder) - alcohol drugs and poisons - duration of exposure - clothing - level of activity

Answer 436

1. Remove the patient from the cold environment (remove any wet clothing and place blankets) 2. Handle the patient gently (rough handling can cause V-FIB ) 3. Maintain adequate oxygenation (94%+, use warm humfied O2 if possible and do not hyperventilate the patient, they have less need for O2 due to their reduced metabolism) 4. Begin CPR if the patient goes into cardiac arrest 5. Actively rewarm the patient. Only those with a body temp less than 34⁰ of 93.2⁰F and 15 minutes away from facility.(aggressively applying heat with heat packs under armpits, hot bottles in groin, using blankets, hot packs on the chest, and turning on the ambulance heater. HEAT SHOULD BE ADDED GRADUALLY. body temp should not be increased more than 1⁰ per hour. Do not apply heat the patient extremities. 6. Passively rewarm the patient. Mild hypothermia are those with a body temp greater than 34⁰ and or 93.2⁰F. Prevent further heat loss using balances and ambulance heater 7. Do not allow the patient to consume stimulants such as tobacco , coffee or alcohol 8. Never rub or massage , patients' arms or legs (you could force cold blood into the heart) 9. Transport (some protocols need you to transport to a facility with ExtraCorporeal Membrane Oxygenation (ECMO) capabilites.

Answer 437

Heat stroke has a mortality rate of 21-63% and it occurs when the body's heat regulating mechanics breakdown and become unable to cool the body sufficiently.The body core temperature reaches extremely high temperatures, usually higher than 105⁰F or 40.5⁰ .Excessively high heat load on the body causes tissue damage and organ dysfunction and failure. Sweating ceases in half of the patients, ½. Nonexcertional: occurs typically to elderly patients with sedentary lifestyles , patients who are chronically ill or on medications , inhibiting the temperature ability of the body, or patients who live in the regions of the country that experience summer heat waves. Excertional: commonly occurs in younger and healthy individuals who are engaged in straining physical exertion in a hot environment for prolonged periods. Sweating is present in half the patients. * THE PATIENTS WITH HEAT STROKE MAY HAVE DRY OR MOIST SKIN.BECAUSE HALF OF THEM CAN'T SWEAT AND THE OTHER HALF CAN

Answer 438

When the body has maximized the heat dissipating mechanisms to a point where other body systems are starting to dysfunction. it can produce a disturbance of the body's blood flow, resulting in a mild state of shock. This is brought on by the pulling of blood in the vessels, just below the skin, resulting from vasodilation as the body works to increase heat, but in extreme cases, this can also cause excessive blood flow away from major organs of the body. the patient's skin is normal to cool in temperature and either pale or ashen gray in color and sweaty

Answer 439

That the patient not be removed from water until a backboard or other rigid support can be applied to the patient for stabilization. If a backboard is not feasible such as in a swift moving water, remove the patient from the water and apply spine motion restriction after they are removed.

Answer 440

It occurs as a result of the bubbles formed from the expansion of nitrogen in the blood and tissues described in Henry's law. The bubbles can cause cell damage and lead to organ dysfunction. The bubbles have 2 primary effects on the body. (1) they act as emboli and cause obstruction circulation and (2) they compress or stretch the blood vessels and nerves. Also , the bubbles can cause coagulation of the blood. In response, the vessels and surrounding tissue release substances as they would in an allergic reaction.

Mid-Term Flashcards

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