Random Anatomy
What makes up the Appendicular Skeleton vs Axial skeleton?
Appendicular (Appendages, Arms, Pectoral girdle, Pelvic Girdle, Shoulder Girdle, legs)
Axial (Axis of body - skull, facial bones, spinal column vertebrae, costals, sternum)
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 (suck in air like a vacuum)
What is the GCS score for this patient
Opens eyes to pain, incoherent garbled speech, Localizes to pain
2 + 2 + 5 = 9
What is distributive shock? What are the 4 types of Distributive Shock? What are key features of each?
Problem with the cardiovascular system specifically with the blood vessels- widespread vasodilation --> not able to constrict appropriately
Neurogenic, Anaphylactic, Psychogenic, Septic
Neurogenic: spinal cord trauma --> disconnect b/w sympathetic nervous system and body --> widespread vasodilation below injury site --> drop in bp (without ability to compensate with HR if injury is high enough)
Anaphylactic: overreaction of body to allergen --> histamine/leukotrine release --> bronchoconstriction and widespread vasodilation--> drop in bp, wheezing (lower) and stridor (upper)
Psychogenic: vasovagal response --> widespread vasodilation tanks bp --> pt faints (usually resolvable when patient is in supine position)
Septic: typically associated with immune response to bacterial pathogen, pathogen emits toxins that do damage to blood vessels causing increasing permeability --> fluid in interstitial spaces + widespread vasodilation --> hypotension
Typically associated with high fever, pink, hot skins (early) and w/out body will cool down unable to regulate its temp with increasing pallor, and AMS as sepsis induced hypovolemia progresses
How often do we reassess a patient? Stable vs unstable? What is reassessment?
We reassess Q5 for unstable or Q15 for unstable
Any change in patient status we will reassess
If a patient was formerly unstable and now are stable we will still reassess them every 5 minutes bc of the potential they could change status.
We start back over with the primary assessment AVPU, ABCs...etc
What are upper vs lower airway structures?
Upper: nares, nasopharynx, os, oropharynx, epiglottis, larynx
Lower: trachea, bronchi, bronchioles, alveoli
What is pulmonary edema and what can cause pulmonary edema? What is EMT Rx?
Fluid in the alveoli
Left Sided CHF, Chemicals/Toxin inhalation, and High Altitude
EMT Rx: CPAP (if local protocols allow), if not high flow O2 15LPM NRB or BVM based on patients presentation/LOC
Compare Systemic Circulation vs Pulmonary Circulation
Systemic Circulation: Oxygenated blood leaves the Left Ventricle via the Aorta and travels around the body through the arteries to the arterioles where O2 is exchanged at capillary beds at cells/tissues/organs via diffusion. Waste products from the cells diffuse into the capillary beds into venules into veins that carry the deoxygenated blood back up to the Superior/Inferior Vena Cava to the Heart
Pulmonary Circulation: Deoxygenated Blood travels from the Right Atrium to the Right Ventricle via Tricuspid valve to the Right Ventricle to the Pulmonary Artery to the Lungs to be oxygenated via External Respiration at the alveoli. Oxygenated blood travels back to the heart via Pulmonary Vein to the Left Atrium through Mitral/Bicuspid valve to the Left Ventricle (LEFT VENTRICLE PUMPS BLOOD TO THE AORTA TO ALL OF SYSTEMIC CIRCULATION)
What are the 3 main conditions associated with Obstructive shock? what are the signs and symptoms of each?
Cardiac Tamponade - blood/fluid fills pericardial sac around heart, preventing heart from contracting appropriately (Beck's Triade: narrowing pulse pressure, muffled heart tones, JVD)
Pulmonary Embolism - sob, pinpoint chest pain (pleuritic pain), circumoralcyanosis, increasesd rr, use of accessory muscles, pain when taking a deep breath,
Tension Pneumothorax - pneumo develops and causes cardiac compromise, increasing intrathorasic pressure leads to collapse of lung and pressure on vena cava, causes reduced blood flow to the heart can cause diminished/absent lung sounds (late), tracheal deviation (late sign)
Mild: encourage coughing, give O2, monitor
Severe: if conscious we do abd thrusts, if unconscious we do modified cpr
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
What is Hypoxic Dive? What disease process is this commonly found in? Why is this dangerous? What to to do as an EMT?
Backup body pathway that causes inspiration based on O2 levels instead of CO2 levels. Commonly found in COPD patients due to chronically low O2 levels
COPD patients can develop oxygen toxicity if they receive too much oxygen which can lead to respiratory depression
EMT Rx: still give O2 if needed (patient showing signs of dyspnea), but titrate as appropriate for patient to avoid Ox tox
What is stable Angina? How is it different than an AMI?
Ischemia leads to 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 but experience ischemia
What are the two types of Hypovolemic shock and what can cause them?
Hemorrhagic: trauma: external bleeding amputation, internal bleeding like: GI/GU bleed, OBGYN emergency, aortic dissection...etc
Non-Hemorrhagic: dehydration from excessive exercise/sweating, vomiting, diarrhea, third spacing of fluid with cirrhosis and burns
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
Give patient O2 as needed for signs of hypoperfusion
What is the function of the Sympathetic Nervous System
To compensate for changes in body systems and blood pressure (fight-or-flight):
Dilates blood vessels in muscles, heart, lungs
Increases RR
Increases HR
Constricts BV to skin/periphery, and GI to raise bp
Increases blood glucose levels
If a pt is breathing rapid and shallow with copious amounts of blood in their mouth how do we manage their airway?
What should we be aware of?
Alternating suctioning with Positive Pressure Ventilations 15LPM high flow O2 (BVM)
Be aware of potential for suctioning induced hypoxia, also be aware we may need to place an airway adjunct if airway is not maintainable
Don't exceed duration of time: 5 seconds of suctioning for infants, 10 for peds, 15 seconds for adults; Follow up with 2 minutes of PPV
What is AMI and what causes it?
What is EMT treatment?
Acute Myocardial Infarction = heart muscle cell death
poor cardiac tissue perfusion due to a blocked coronary artery (can be caused by cholesterol/calcium plaque or air 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
EMT treatment = BLS assessment, administer O2 as needed, ASA, NTG (make sure to do the 5 rights of med administration), rapid transport
What defines Compensated vs Decompensated Shock?
Decompensated shock occurs when the compensatory mechanisms get overwhelmed and fail, systolic blood pressure drops below 90 (benchmark of change- late finding)
Common Meds to administer as an EMT and routes of administration, indications for each
O2 (Inhalation), (shock, chest pain, respiratory problems, hypoxia, apnea, pallor, blood loss, severe pain, nausea, comfort...etc)
NTG (Sub lingual and Transcutaneous) (chest pain of suspected cardiac origin) 0.4mg dissolvable tablet or spray
ASA (PO) (chest pain of suspected cardiac origin), 2-4, 81mg chewable tablets
Epinephrine via Epi-pen (IM), 0.3mg for adult, 0.15mg for peds (under 15kg) anaphylactic rxn with signs of respiratory compromise/lower airway swelling (wheezing)/upper airway swelling (stridor), angioedma
Albuterol via MDI (Inhalation) 1 puff for asthma, obstructive pulmonary disease, respiratory symptoms (dyspnea, cyanosis, increased RR, labored breathing) w/or wo wheezing
Narcan (IN) suspected opioid overdose with respiratory depression, pinpoint pupils, 2mg/2mL total, 1mL/nostril
Glucose (PO), gel or tablet, 1/2 tube to full tube = 7.5g-15g sugar; for altered patient w/ hypoglycemia, pt has to be able to protect their airway
Activated Charcoal (PO) suspension given to toxin ingestion, pt has to be able to protect their airway
What is Dyspnea? How do you identify it in your patients?
What could tell us they have progressed to apnea?
SOB or Difficulty Breathing
- increased rr
- use of accessory muscles
- restlessness
- head bobbing
- nasal flaring
- tripoding
- air hunger
- skins pale, cool, diaphoretic
Apnea (absence of breathing, respiratory failure)
- agonal respirations (guppy)
- mental status change (unresponsive)
- lack of muscular movement of diaphragm
- skin sign changes: profound cyanosis
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/CHF), grunting (bronchiolitis, asthma, COPD)
Describe electric pathway conduction though the heart. & Why is there a pause at the AV node?
SA (natural pacemaker)-> Internodal pathway -> AV -> bundle of his -> L/R bundle branches --> Purkinje fibers (allow simultaneous ventricular contraction)
Pause at the AV node allows ventricles to fill with blood
Skin signs associated with each type of shock
Psychogenic: pale, cool, diaphoretic
Anaphylactic: warm, flushed, sweaty, urticaria, angioedema
Septic: warm, pink, dry or diaphoretic
Neurogenic: pale, cool, diaphoretic above and warm, pink, normal below line of injury
Cardiogenic: pale, cool, diaphoretic
Obstructive: pale, cool, diaphoretic
Hypovolemic: pale, cool, diaphoretic
FOR CPR: What is the correct compression to ventilation ratio for each age group? Infant, Ped, Adult
What is the correct compression depth for each age group?
What is the correct BVM ventilation rate for each age group?
For infant and peds if 2 rescuers 15:2, if one rescuer 30:2; For adults always 30:2
For all ages 1/3 the A-P diameter of the chest: for infants 1.5", for peds 2", for adults at least 2"
For infants and peds 1 breath every 2-3 seconds, for adults 1 breath every 5-6 seconds