Random Anatomy
What makes up the Appendicular Skeleton?
Arms, Legs, Pelvic Girdle, Shoulder Girdle
What is negative pressure breathing? (definition and physiology)
Normal ventilation process
Volume of the lungs increases as diaphragm contracts/drops down and intercostal muscles lift the ribcage up and out -->The Pressure in the thoracic cavity to drop
Why is the left ventricle larger than the right?
What is the name of the condition associated with abnormal enlargement of the left ventricle? Why is this a detriment to the patient?
It pumps blood to aorta and systemic circulation.
Left Ventricular Hypertrophy- higher muscularture of the left ventricle decreases the amount of volume of blood that can enter and exit the heart --> reducing CO
What is distributive shock? What are the 4 types of Distributive Shock?
Problem with the cardiovascular system specifically with the blood vessels, Neurogenic, Anaphylactic, Psychogenic, Septic
Common Meds to administer as an EMT and routes of administration, indications for each
O2 (IN), (shock, chest pain, respiratory problems, hypoxia, poor perfusion, severe pain...etc)
NTG (Sub lingual and Transcutaneous) (chest pain of suspected cardiac origin) 0.4mg dissolvable tablet
ASA (PO) (chest pain of suspected cardiac origin), 4, 81mg chewable tablets
Epinephrine via Epi-pen (IM), 0.3mg for adult, 0.15mg for peds anaphylactic rxn with respiratory compromise/lower airway swelling (wheezing)/upper airway swelling (stridor)
Albuterol via MDI (IN) asthma, obstructive pulmonary disease, respiratory symptoms (dyspnea, cyanosis, increased RR, labored breathing) w/or wo wheezing
Narcan (IN) suspected opioid overdose with respiratory depression, 2mg total 1mg/nostril
Activated Charcoal (PO) suspension given to toxin ingestion,
Glucose, (hypoglycemia) 15g/15min pt has to be able to protect their airway
What is Dyspnea? How do you identify it in your patients?
SOB or Difficulty Breathing
- increased rr
- use of accessory muscles
- restlessness
- head bobbing
- tripoding
What can cause acute pulmonary edema?
Left Sided CHF and Toxin inhalation and High Altitude
Pulmonary Circulation vs Systemic Circulation
Systemic Circulation: Oxygenated blood leaves the left ventricle via the Aorta and travels around the body through the arteries to the tissues where O2 is exchanged at capillary beds via diffusion and deoxygenated blood is transported back up to the heart via veins to the Superior/Inferior Vena Cava
Pulmonary Circulation: Deoxygenated Blood travels from the Right Ventricle via Pulmonary Artery to the Lungs to be oxygenated via External Respiration at the alveoli. Oxygenated blood travels via Pulmonary Vein to the Left Atrium
What are the 3 main conditions associated with Obstructive shock? what are the signs and symptoms of each?
Cardiac Tamponade (Beck's Triade: narrowing pulse pressure, muffled heart tones, JVD)
Pulmonary Embolism - sob, pinpoint chest pain (pleuritic pain), circumoralcyanosis, use of accessory muscles, pain when taking a deep breath,
Tension Pneumothorax - diminished/absent lung sounds, tracheal deviation (late sign)
If you are off-duty and witness a child go into cardiac arrest what should you do first?
If you come across a pt (it is unwitnessed) what should you do?
call 911 then begin CPR
if your phone is not nearby and you do not witness then do CPR first and go to call 911 after 2 minutes of CPR
What abdominal organ does Cirrhosis/Hepatitis mainly affect?
Liver
What is Hypoxic Dive? What population is this commonly found in? Why is this dangerous?
Backup body pathway that causes inspiration based on O2 levels instead of CO2 levels. COPD patients can develop oxygen toxicity which can lead to respiratory depression
What is stable Angina? How is it different than an AMI?
Heart cell injury that leads to chest pain that resolves with rest or nitroglycerin administration
NOT a heart attack (AMI) because the heart cells are still alive
Angina is caused by ischemia
What are the two types of Hypovolemic shock and what can cause them?
Hemorrhagic: trauma: external bleeding amputation, internal bleeding, GI/GU bleed
Non-Hemorrhagic: dehydration from excessive exercise/sweating, vomiting, diarrhea
If a pt has a significant drop in BP and complains of dizziness post med administration, what will you do and why?
Lay pt supine to help assist with maintaining blood pressure and blood volume return to the heart
List areas of the spinal column in descending order with number of vertebrae for each and total
Cervical (7), thoracic (12), lumbar (5) sacral + coccyx (9) = total of 33 vertebrae
If a pt is breathing rapid and shallow with copious amounts of blood in their mouth how do we manage their airway?
Alternating suctioning with Positive Pressure Ventillations
What is AMI and what causes it?
heart muscle cell death
poor cardiac tissue perfusion due to a blocked coronary artery (can be caused by cholesterol plaque or fb embolism or thrombus) leading to ischemia of heart muscle cells. heart cells build up lactic acid metabolic waste products because no blood to remove waste products of metabolism, then burst leaking their contents into other nearby cells --> rapid progression of heart cell death
What defines Compensated vs Decompensated Shock?
Decompensated shock occurs when the compensatory mechanisms get overwhelmed and fail, systolic blood pressure drops below 90
What are agonal respirations indicative of?
Guppy breathing = Not effective ventilation
Need Positive Pressure Ventilation.
Can be found in CPR status patients
What is the function of the Sympathetic Nervous System
To compensate for changes (fight-or-flight)
Dilates blood vessels in muscles, heart, lungs
Increases RR
Increases HR
Constricts BV to skin/periphery, and GI
Upper Airway vs Lower Airway sounds and what conditions do we see them with?
Upper: stridor or seal bark cough (airway obstruction, croup), Snoring (fb airway obstruction or tongue), Bubbling, gurgling (saliva, emesis, blood...etc liquid in airway)
Lower:
wheezing (asthma and anaphylaxis), Ronchi (course crackles with pneumonia, COPD), Rales (fine crackles with pulmonary edema), grunting (bronchiolitis, asthma, COPD)
Describe electric pathway conduction though the heart. & Why is there a pause at the AV node?
SA -> Internodal pathway -> AV -> bundle of his -> L/R bundle branches --> Purkinje fibers
Pause at the AV node allows ventricles to fill with blood
Skin signs associated with each type of shock
Neurogenic: pale, cool, diaphoretic above (still intact sympathetic response) and warm, pink, normal below line of injury
Obstructive: pale, cool, diaphoretic
Cardiogenic: pale, cool, diaphoretic
Hypovolemic: pale, cool, diaphoretic
Anaphylactic: warm, flushed, sweaty, erythema, urticaria, angioedema, will progress to pale cool diaphoretic
Psychogenic: suddenly pale, cool, diaphoretic until after supine for about 5ish minutes they will go back to normal
Septic: warm, pink, dry or diaphoretic will progress to cool pale diaphoretic
Hypoxia