Block 2 Study Guide

Block 2 Study Guide Cardiac Tamponade 1. Remember medical assessment when answering questions (order of operations!) a. Scene Size-up b. Primary Assessment c. History Taking d. Secondary Assessment e. Reassessment 2. Review the O2 cheat sheet a. 3. Know your lung sounds & what they indicate/where they’re heard a. Normal breath sounds. These are clear and relatively quiet during inspiration and expiration b. Snoring breath sounds. These usually indicate a simple, but potentially dangerous upper airway obstruction, usually caused by the tongue or a foreign body c. Wheezing breath sounds. These suggest an obstruction or narrowing of the lower airways, most prominent on expiration d. Crackles. Wet, crackling breath sounds, usually both inspiration and expiration, may indicate fluid in the lungs e. Rhonchi. Congested breath sounds may suggest the presence of mucus in the lungs. Expect to hear low-pitched, noisy sounds that are most prominent on expiration f. Stridor. This is often heard before even listening with a stethoscope and may indicate that the patient has an airway obstruction in the neck or upper part of the chest. Expect to hear a brassy, crowing sound that is most prominent on inspiration 4. What is the difference between assisted & artificial ventilations? When do we use them? a. Assisted ventilation: purpose is to improve overall oxygenation and ventilatory status of the patient; use when a patient is in severe respiratory distress or respiratory failure and not breathing adequately b. Artificial ventilation: purpose is to give ventilation; use when patients who are in respiratory arrest 5. What is passive ventilation? a. Movement of air in and out through chest compressions 6. When would you use the mouth to mask technique for providing ventilations? a. Artificial Ventilation technique b. For patients who are in respiratory arrest 7. Know airway suctioning times for adults, children & infants a. Adults: <= 15 seconds b. Children: <= 10 seconds c. Infants: <= 5 seconds 8. What is external respiration? a. External respiration (pulmonary respiration) is the process of breathing fresh air into the respiratory system and exchanging oxygen and carbon dioxide between the alveoli and the blood in the pulmonary capillaries Block 2 Study Guide 9. What do chemoreceptors sense? a. Chemoreceptors monitor the levels of oxygen, carbon dioxide, hydrogen ions, and the pH of the cerebrospinal fluid b. Central chemoreceptors in the medulla respond quickly to slight elevations in carbon dioxide or a decrease in the pH of the cerebrospinal fluid c. Peripheral chemoreceptors, in the carotid arteries and the aortic arch, are sensitive to decreased levels of oxygen in arterial blood as well as to low pH levels 10. What is the most significant issue with suctioning a patient’s airway? (*hint: what else are we suctioning out besides secretions?) a. Besides secretions or vomitus, suction units also have to deal with solid objects such as teeth, foreign bodies, and food 11. What is the hypoxic drive & what does it do? a. A secondary control of breathing that is based on levels of oxygen dissolved in plasma (usually for patients with COPD who always have high level of CO2) b. This is as opposed to the primary control of breathing that uses carbon dioxide as the driving force 12. Know the indications/contraindications for using OPAs & NPAs a. OPA i. Indication (1) Unresponsive patients without a gag reflex (breathing or apneic) (2) Any apneic patient being ventilated with a BVM ii. Contraindication (1) Conscious patients (2) Any patient (conscious or unconscious) who has an intact gag reflex b. NPA i. Indication (1) Semiconscious or unconscious patients with an intact gag reflex (2) Patients who otherwise will not tolerate an OPA ii. Contraindication (1) Severe head injury with blood draining from the nose (2) History of fractured nasal bone 13. When would use of a CPAP be indicated? a. Alert and able to follow commands b. Obvious signs of respiratory distress c. Breathing rapidly, >26 breaths/min d. Pulse oximetry reading <90% 14. What is alkalosis? a. Alkalosis is the buildup of excess base in the bodily fluids b. Caused by hyperventilation 15. What would cause hyperventilation? a. Compensating acidosis, the buildup of acid in blood, causes hyperventilation i. Diabetic & high glucose, Overdose of aspirin, Severe infection b. Over breathing to the point where CO2 falls below normal 16. What is hypoxemia? Block 2 Study Guide a. Hypoxemia is a below-normal level of oxygen in your blood, specifically in the arteries 17. Know S&S, treatments + risk factors of anaphylaxis, acute hyperventilation syndrome, compensated shock, cardiogenic shock, CHF a. Anaphylaxis i. S&S (1) Develop w/in seconds (2) Mild itching/rash (3) Burning skin (4) Vascular dilation (5) Generalized edema (6)Coma (7) Rapid death ii. Treatment (1) Immediate transport (2) High flow oxygen (10-15 L/min), Assist ventilations with a BVM (3) Determine cause (4)Epinephrine b. Acute Hyperventilation Syndrome i. S&S ii. Treatment c. Compensated shock i. S&S (1) Agitation, Anxiety, Restlessness (2) Feeling of impending doom, altered mental status (3) Weak, rapid (thready), or absent pulse (4) Clammy (pale, cool, moist) skin (5) Pallor, with cyanosis about lips (6) Shallow, rapid breathing (7) Air hunger (shortness of breath) (8) Nausea or vomiting (9) Capillary refill of longer than 2 seconds (10) Marked thirst (11) Narrowing pulse pressure ii. Treatment d. Cardiogenic shock i. S&S (1) Chest pain (2) Irrefular pulse (3) Weak pulse (4) Low blood pressure (5)Cyanosis (6) Cool, clammy skin (7)Anxiety (8)Crackles Block 2 Study Guide (9) Pulmonary edema ii. Treatment (1) Position comfortably (2) Administer high-flow oxygen (3) Assist ventilations e. CHF i. S&S ii. Treatment 18. How often do you reassess critical patients? What about stable patients? a. Unstable: every 5 minutes b. Stable: every 15 minutes 19. Hypoperfusion = shock a. Hypoperfusion = shock 20. How many doses of epinephrine can we give? (*hint: 1 without contacting medical control, 2+ potentially after contacting medical control) a. IM (intramuscular), 1:1000 b. 1 without contacting medical control c. 2+ potentially after contacting medical control 21. What would cause cardiac output to decrease? Why? a. A heart rate too slow or too fast will reduce cardiac output b. When the heart beats too rapidly, there is not enough time between contractions for the heart to refill completely c. When the heart beats too slowly, the volume of blood circulated per minute decreases due to the slow pulse rate 22. Where can you palpate the posterior tibial pulse? a. Posterior tibial pulse is felt on the inside of the ankle 23. What is ischemic heart disease? a. Disease involving a decrease in blood flow to one or more portions of the heart muscle 24. Why is ventricular fibrillation the most common cause of cardiac arrest following an AMI? a. 25. Know 6 Rights & DDICE + why we administer them/what they do for all EMT administered medications a. 6 rights i. Right patient ii. Right medication iii. Right dose iv. Right route v. Right time vi. Right documentation b. DDICE i. Drug ii. Dose iii. Integrity (packaging is intact) iv. Clarity Block 2 Study Guide v. Expiration date c. Circumstances i. Peer-assisted medication: to partner ii. Patient-assisted medication: patient’s own medication iii. EMT-administered medication: direct administering to patient 26. What are the expected affects of nitroglycerin & epinephrine? a. Nitroglycerin i. Relaxes the muscular walls of coronary arteries & veins ii. Results in less blood returning to the heart iii. Decreases blood pressure iv. Relaxes arteries throughout the body v. Often causes a mild headache and/or burning under the tongue after administration b. Epinephrine i. Dilates passages in the lungs ii. Constricts blood vessels, causing increased blood pressure iii. Increases heart rate and blood pressure 27. Where do you do chest compressions on an adult patient in cardiac arrest? a. Chest compressions are administered by applying rhythmic pressure and relaxation to the lower half of the sternum (heart is located slightly to the left) 28. What depth do we compress for infants? a. 1.5 inches 29. What is the minimum amount of chest compressions that should be delivered within one minute? a. 100 30. Where do we palpate the pulse on an infant? (*hint it’s not the carotid artery) a. Palpate the brachial pulse, located at the medial area of the upper arm, in infants 31. What is the ratio of compressions to ventilations for 2 rescuer CPR? a. 30:2 32. If you can’t reach around to the abdomen for a conscious choking victim, where would you go? a. Use chest thrusts 33. What 3 bones make up the pelvic bone? a. Sacrum and 2 pelvic bones 34. Your hip joint is formed by what? a. A ball-and-socket joint connects the acetabulum and femur i. Acetabulum is the part of the pelvis where leg connects to the hip joint ii. Acetabulum is formed where the ilium, ischium, and pubic bones meet 35. Why do we breathe? Is it due to oxygen or CO2? a. Primary control of breathing uses carbon dioxide as the driving force b. Secondary control of breathing bases on levels of oxygen dissolved in plasma (usually for patients with COPD who always have high level of CO2) 36. What is cardiac output? What is it affected by? a. Cardiac output = Heart rate x Stroke Volume (Volume per contraction) b. Stroke Volume is affected by: Block 2 Study Guide i. Preload ii. Afterload iii. Contractility 37. What is the primary function of the spleen? a. Filtering worn out blood cells, foreign substances, and bacteria b. Recycles hemoglobin c. Assist immune response 38. Know what systole & diastole are (as in the cardiac cycle) a. Systole: muscular contraction phase b. Diastole: phase where ventricles muscles relax and fill with blood 39. What layer of skin contains fatty tissue (aka adipose tissue)? a. Below the skin is a layer of subcutaneous tissue composed largely of fat i. This subcutaneous tissue lies immediately under the dermis, a layer of skin 40. Know what proximal & distal mean a. Proximal: closer to the trunk b. Distal: further from the trunk or nearer to the free end of the extremity 41. What would indicate a patients’ short-term memory is intact? (Think PPPT) a. Short-term memory: time when asking approximate date and event b. Intermediate memory: place and time when asking year or month c. Long-term memory: person and place 42. Be able to calculate a GCS score (only 1 question) Eye Opening Best Verbal Response Best Motor Response (4) Spontaneous (5) Oriented conversation (6) Obeys commands (3) In response to speech (4) Confused conversation (5) Localizes pain (2) In response to pain (3) Inappropriate words (4) Withdraws to pain (1) None (2) Incomprehensible sounds (3) Abnormal flexion (1) None (2) Abnormal extension (1) None a. (13-15) mild dysfunction, although 15 is maximum b. (9-12) moderate dysfunction c. (<= 8) severe dysfunction 43. S&S of liver dysfunction a. 44. Where would we expect to find subcutaneous emphysema? a. 45. Know what systolic & diastolic pressures are a. Systolic pressure: increased pressure that is caused along the artery with each contraction (systole) of the ventricles and the pulse wave that it produces b. Diastolic pressure: residual pressure that remains in the arteries during the relaxing phase of the heart’s cycle (diastole), when the left ventricle is at rest 46. What is a palpated blood pressure? a. When it is difficult to obtain an auscultated blood pressure by hearing, obtain a palpated blood pressure through feeling pulse Block 2 Study Guide 47. When do we do a head-to-toe exam? Why do we do it? a. The physical examination may be a systematic head-to-toe secondary assessment or an assessment that focuses on a certain area or system of the body, often determined by the chief complaint b. Circumstances will dictate which aspects of physical examination will be used 48. What is capnography? When do we use it? a. Capnography is a noninvasive method that can quickly and efficiently provide information on a patient’s ventilation, circulation, and metabolism b. We use it when we want to measure the amount of carbon dioxide in exhaled air to understand the degree to which a patient is adequately perfused and ventilated 49. What is a pertinent negative? a. A pertinent negative is a sign & symptom the patient does not have 50. How long can a person reasonably compensate for shock? What would happen as time goes on? a. Less than 5 minutes for compensated shock b. Decompensated shock: i. Falling blood pressure ii. Labored/irregular breathing iii. Ashen, mottled, or cyanotic skin iv. Thready or absent peripheral pulses v. Dull eyes, dilated pupils vi. Poor urinary output 51. What are the bones found within the forearm? a. Forearm is composed of the radius and the ulna 52. Know what happens during inhalation and exhalation a. Inhalation (active): When a person inhales, the diaphragm and intercostal muscles contract, allowing air to enter the body and travel to the lungs. When it contracts, the diaphragm moves down slightly, enlarging the thoracic cage from top to bottom b. Exhalation (passive): During exhalation, the diaphragm and the intercostal muscles relax. When the size of the thoracic cage decreases, air in the lungs is compressed into a smaller space 53. What is negative-pressure breathing? a. Air is sucked into the lungs due to the negative intrathoracic pressure created when the diaphragm contracts 54. Know what residual volume is and what happens to residual volume as a person ages a. The air that remains in the lungs after maximal expiration b. Residual volume increases with age 55. Risk factors for diabetes mellitus a. 56. What age do we start measuring blood pressure? (*hint 3 years of age) a. Measure blood pressure in all patients older than 3 years 57. Difference between aerobic and anaerobic respiration a. function without oxygen and a lower energy output b. buildup of lactic acid, metabolic acidosis and more wate products Block 2 Study Guide 58. What is the most common cause of prehospital cardiac arrests? a. Coronary artery disease is the most common cause 59. What is the compression depth for an adult? a. 2 to 2.4 inches 60. What do we do when we start to notice gastric distention? What is gastric distention? a. Gastric distention is a condition in which air fills the stomach, often as a result of high volume and pressure during artificial ventilation b. What to do when we start to notice: i. Ensure that the patient’s airway is appropriately positioned ii. Ventilate the patient at the appropriate rate iii. Ventilate the patient with the appropriate volume c. Manual decompression should only be used as last resort, will result in vomiting 61. What do we do to relieve choking in a responsive infant? a. Perform back slaps and chest thrusts b. Using abdominal thrusts will injure the infant 62. What is the purpose of a secondary assessment in a medical assessment? a. The purpose of the secondary assessment is to perform a systematic physical examination of the patient 63. Know the circulation of blood flow through the heart a. Superior/Inferior Vena Cava Right Atrium (Tricuspid Valve) Right Ventricle (Pulmonary Valve) Pulmonary Arteries Pulmonary Veins Left Atrium(Bicuspid/Mitral Valve) Left Ventricle (Aortic Valve) Aorta 64. Know the cardiac conduction system a. SA (sinoatrial) node AV (atrioventricular) node bundle of His Purkinje fibers 65. What are the functions of the sympathetic nervous system? a. “Fight-or-Flight” i. Increased heart & respiratory rate, pupil dilation, decreased digestion, increased blood flow to muscles 66. What could cause a patient to start seizing following delivery of Narcan for an opioid overdose? a. Withdrawal symptoms, which include both seizures and cardiac arrest b. Administer naloxone (Narcan) in increments of 0.4 mg 67. What is Alupent used to treat? Why? a. Used to treat wheezing and shortness of breath that commonly occur with lung problems (e.g., asthma, chronic obstructive pulmonary disease) b. Maintenance inhalers are not useful for a patient suffering acute respiratory distress and in need of immediate relief 68. What does transcutaneous mean? (*hint sometimes referred to as transdermal). What medications are delivered this way? a. Through the skin; delivered this way for longer-lasting effect i. Nicotine patch ii. Nitroglycerin patch 69. Why do elderly patients have slower absorption rates for medications? Block 2 Study Guide a. Absorption is slowed by decreased gastric acid content, which slows GI emptying and GI motility 70. What is hypoglycemia? a. Extremely low blood glucose level, caused by an excess of insulin 71. What is a mucosal atomizer device? What route is it used to deliver medications through? a. The liquid medication is aerosolized and is administered into a nostril b. Intranasal; relatively new format; head and face are very vascular so absorption is quick 72. When is IO (intraosseous) access used? Why? a. Into the bone; medications given by this route reach the bloodstream through the bone marrow; very painful, involves bone drilling b. Used when patient is unconscious; often used for children who have fewer available (or difficult to access) IV sites 73. What is JVD (jugular vein distention) a. A visual bulging of the jugular veins in the neck that can be caused by fluid overload, pressure in the chest, cardiac tamponade, or tension pneumothorax 74. If you can’t get an automatic blood pressure reading what should you do? a. 75. When is ETCO2 (end-tidal carbon dioxide) monitoring used? a. To more accurately assess ventilation. Pulse oximetry cannot measure the effectiveness of ventilation nor provide information about respiration 76. How is TB spread? a. TB spreads by cough; airbone transmission 77. Viral hepatitis vs toxin-induced hepatitis (which one is communicable?) a. Viral hepatitis 78. What is MRSA? a. A bacterium that causes infections and is resistant to many antibiotics